Performance of Noninvasive Partial CO2 Rebreathing Cardiac Output and Continuous Thermodilution Cardiac Output in Patients Undergoing Aortic Reconstruction Surgery
Performance of Noninvasive Partial CO2 Rebreathing Cardiac Output and Continuous Thermodilution Cardiac Output in Patients Undergoing Aortic Reconstruction Surgery
复制标题
接受主动脉重建手术的患者无创部分 CO2 再呼吸心输出量和连续热稀释心输出量的表现
作者：
Y. Kotake;Kiyoshi Moriyama;Y. Innami;H. Shimizu;T. Ueda;H. Morisaki;J. Takeda
背景：在部分二氧化碳再呼吸法中，监测到的二氧化碳排出变化和呼气末二氧化碳对短暂的再呼吸期的反应被用来估计心输出量。然而，缺血和再灌流期间二氧化碳产生的动态变化可能会影响这些估计的准确性。本研究旨在比较部分二氧化碳再呼吸(NICO)、团注(BCO)和持续热稀释(CCO)三种监测心输出量的方法所产生的心输出量。方法应用NICO和CCO连续监测28例主动脉重建患者的心输出量。在血流动力学达到稳定时测量BCO：(1)麻醉诱导后；(2)主动脉阻断时；(3)髂动脉再灌流时；(4)腹膜关闭时。结果NICO和BCO之间的偏差和精密度(1 SD)分别为−0.5 8±0.9 L/m in和0.38±1.17 L/m in。NICO和BCO之间的偏差在麻醉诱导后和阻断期间较小，但在再灌流后增加。在再灌流前，CCO和BCO之间的偏差相对较小，但在腹膜关闭时显著增加。结论在主动脉重建手术中，NICO监测的性能与CCO相当，但这两种连续测量设备的偏向正好相反。
Background In the partial CO2 rebreathing method, monitored changes in CO2 elimination and end-tidal CO2 in response to a brief rebreathing period are used to estimate cardiac output. However, dynamic changes in CO2 production during ischemia and reperfusion may affect the accuracy of these estimates. This study was designed to compare measurements of cardiac output as produced by the partial CO2 rebreathing (NICO), bolus (BCO), and continuous thermodilution (CCO) methods of monitoring cardiac output. Methods Cardiac output was continuously monitored using both NICO and CCO in 28 patients undergoing aortic reconstruction. BCO measurements were taken at the following intervals when hemodynamic stability was achieved: (1) after anesthetic induction; (2) during aortic cross-clamp; (3) at reperfusion of the iliac artery; and, (4) during peritoneal closure. Results The bias and precision (1 SD) derived from all the measurements between NICO and BCO was −0.58 ± 0.9 l/min, whereas for CCO and BCO it was 0.38 ± 1.17 l/min. The bias between NICO and BCO was small after anesthetic induction and during cross-clamp, but increased following reperfusion. The bias between CCO and BCO was relatively small until reperfusion but increased significantly at peritoneal closure. Conclusions Results indicate that in aortic reconstruction surgery the performance of NICO monitoring is comparable with that of CCO; however, the direction of bias in these continuous measurement devices is the opposite.