胸阻抗法检测心脏功能在心脏术后病人监护中的应用

  [摘 要] 目的: 评价胸阻抗法测定心脏手术后心脏功能的可靠性和准确性。方法: 随即选取西京医院心脏外科瓣 膜置换和冠脉搭桥术后病人32 例, 其中男25例, 女7 例, 冠心病病人19 例, 瓣膜病13 例, 平均年龄(55.2±12.3)岁, 分别用胸阻抗法、经胸心脏B超法和心导管法测定病人心脏指数, 作线性相关性分析。结果: 3 种方法测定的心指数 结果无显著差异, 具有良好的相关性, 胸阻抗法与热稀释法的相关系数为 0.84, 胸阻抗法与心脏 B 超法的相关系数为0.81。结论: 胸阻抗法无创心功能测定仪器具有操作简便, 准确性高, 可以连续检测观察病情变化的特点。

[关键词] 胸阻抗; 超声心动图; 热稀释法; 心脏指数 [中图分类号] R331.3+ 1 [文献标识码] A [文章编号] 1671-5098(2008)03-0289-04 

  A Comparative Investigation of Cardiac Function Measurement with Thoracic Impedance Trans-thoracic Echocardiography and Thermo-dilution Methods JIN Zhen-Xiao1 , XIONG Hong-Yan2 ,ZHU Yong-Sheng1 , et al (1.The Affiliated Xijiang Hospital of The Fourth Military Medical University, Xi'an, Shanxi 710032,China; 2.The Central Hospital of Xi'an,Xi'an,Shanxi 710032,China) 

  Abstract: Objective To investigate the reliability and veracity of thoracic impedance in cardiac output measurement. Methods Thirty-two patients (male 25 cases, female 7 cases) with coronary artery disease (19 cases) and rheumatic heart disease (13 cases) were recruited in this study. The mean age of these patients was (55.2±12.3) years. Their cardiac indices were measured with thoracic impedance, trans-thoracic echocardiography and thermo-dilution methods respectively. The statistical consistency of these three methods was evaluated. Results There is no significant difference between these three methods in the measurement of cardiac index in the situation of cardiovascular surgery ICU. The correlation co efficiency between thoracic impedance method and thermo-dilution method was 0.84, and it is 0.81 between thoracic impedance method and trans-thoracic echocardiography. Conclusion The reliability and veracity of thoracic impedance method is comparable to traditional thermo-dilution and echocardiography methods in cardiac index determination. Key words: Thoracic impedance cardiography; Echocardiography; Thermo dilution; Cardiac index 

  血流动力学监测是心脏手术围手术期临床诊疗评估手段中的一项重要内容, 是评价病人预后和调整治疗方案的重要依据。传统的心导管术监测血流动力学是心功能评测的金标准, 但是创伤较大, 操作复杂, 许多患者难以接受和耐受。多年来, 临床医师一直在寻找一种操作简便, 安全, 稳定, 重复性好的监测方法。近年来, 由于计算机技术的飞速发展, 心阻抗微分图等无创性心功能检测方法以其操作简便, 结果可靠, 可以连续观察等有点, 逐渐进入心脏病和重症监护室[1,2] 。

  本文回顾总结了西京医院心脏外科监护病区无创心功能监测的临床应用情况。 1 资料与方法 1.1 资料 所有入选病例均来自西安市西京医院心脏外科住院病人, 共32例, 其中男25例, 女7 例, 冠心病 19 例, 瓣膜病13例, 平均年龄(55.2±12.3)岁。病种为冠心病冠脉架桥术后和瓣膜病瓣膜置换术后病人。1.2 方法无创心功能监测仪器采用香港千帆医疗仪器有限公司CSM- 2 000PA 血流动力监护/ 分析仪, 电极采用香港千帆医疗仪器有限公司公司提供的盘状银- 氯化银电极, 进行阻抗法心功能测定, 信号稳定后, 连续监测1 h, 采集10 个心指数数据。经胸超声心动图采用惠普 SONOS 5 500 型超声 诊断检测仪, 描记 10 个心动周期的舒张末期和收缩末期的左室心腔容积, 计算心排指数。为了避免人为误差, 所有超声心动图检查均由固定的超声诊断医师进行检测。有创心功能检 测采用经右侧颈内静脉留置Swan-Ganz 导管, 温度稀释法检 测, 采集 10 个心指数数据, 由固定的心脏外科 ICU医师进行检测。所有检测进行时, 患者取平卧位