兩種熱稀釋法測量血流動力學參數(shù)在犬失血性休克模型中的比較.pdf
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兩種熱稀釋法測量血流動力學參數(shù)在犬失血性休克模型中的比較
齊志偉 , 王 仲 , 徐 軍 , 梁 璐 , 朱華棟 , 李 毅 , 于學忠 , 馬 遂
[作者單位] 中國協(xié)和醫(yī)科大學中國醫(yī)學科學院北京協(xié)和醫(yī)院急診
科,北京 100730
[作者簡介] 齊志偉(1975 - ) ,男,住院醫(yī)師,博士研究生,急診醫(yī)學
專業(yè)。
[摘 要] 目的 比較經(jīng)肺熱稀釋法和肺動脈導管法測量血流動力學參數(shù)。方法 通過經(jīng)肺熱稀釋法(COa) 、右心漂浮
導管熱稀釋法(COpa)和脈搏誘導持續(xù)心輸出量測量法(COpc)在 20 只犬失血性休克模型制作前后以及應用不同液體容量復
蘇后測量心輸出量和血液動力學參數(shù) ,比較 COa、 COpa、 COpc之間的關系。并且比較經(jīng)肺熱稀釋法、右心漂浮導管熱稀釋法兩
種方法測得的血液動力學參數(shù)(包括 SVRI和 SVI ) 。結果 實驗全程中 COpc、 COa 和 COpc 的相關性好 ,準確性很穩(wěn)定。體循
環(huán)指數(shù)(SVRI)和每搏輸出量指數(shù)(SVI )在經(jīng)肺熱稀釋法和右心漂浮導管熱稀釋法比較中呈正相關。結論 在犬失血性休克模
型中 ,我們發(fā)現(xiàn)與肺動脈導管法相比較 ,經(jīng)肺熱稀釋法測量得到的血流動力學參數(shù)準確穩(wěn)定 ,COpc 準確、可靠 ,體循環(huán)指數(shù)
(SVRI)和每搏輸出量(SVI )在兩種方法中的相關性良好。
[關鍵詞] 脈搏誘導的持續(xù)心輸出量; 失血性休克; 肺動脈導管法; 體循環(huán)指數(shù); 每搏輸出量指數(shù)
[中圖分類號] [文獻標識碼] A [文章編號] 1002 - 1949(2006) 06 - 0439 - 03
Comparison of two kinds of thermodilution methods for the values of hemodynamic Variables in hemorrhaged shock models of dog
QI Zhi - wei , WANG Zhong , XU Jun , et al . Department of Emergency , Peking Union Medical College Hospital , Peking Union Medical Col2
lege , Chinese Academy of Medical Sciences , Beijing 100730 , China
[ Abstract] Objective ①To compare two thermodilution methods for the values of hemodynamic Variables , including cardiac output
(CO) thermodilution in the pulmonary artery (COpa) and thermodilution in the femoral artery (COa) with each other and with CO determined
by continuous pulse contour analysis (COpc) ; to evaluate the accuracy of CO by PICCO. ②To compare the difference of systemic vascular re 2
sistance index(SVRI) and stroke volume index(SVI) between these two methods. Methods In 20 dogs with hemorrhaged shock , hemody 2
namic parameters were evaluated by the 2 kinds of transpulmonary thermodilution technique including Swan - Ganz catheter and pulse induced
continuous cardiac output (PICCO) , before and after hemorrhaged shock , and after volume resuscitation. To compare COa ,COpa ,COpc , and
compare the difference of SVRI and SVI between these two methods. Result Through all the study , correlation and precision of COpc , COpa
vs. COa was stable. SVRI and SVI by these two kinds of thermodilution techniques are correlated. Conclusion In dog models with hemor2
rhaged shock , our findings demonstrate that there are no statistic differences of hemodynamic parameters between by the pulmonary artery ther 2
modilution and by the femoral artery thermodilution. Femoral artery pulse contour CO correlates well with both COpa and COa. SVRI and SVI
also correlate well in these two kinds of thermodilution techniques.
[ Key word] Pulse induced continuous cardiac output ; Pulmonary artery catheter ; Hemorrhaged shock ; Systemic vascular resis2
tance index ; Stroke volume index
臨床醫(yī)師一直在努力尋找能夠反映血流動力學指標的良
好監(jiān)測方法[1]
,既要準確同時還要創(chuàng)傷小。多年來,臨床上較
多應用右心漂浮導管法,該法有一定潛在的并發(fā)癥[2]
,并且其
準確性受到機械通氣的影響。近來,開始出現(xiàn)了對經(jīng)脈搏誘
導持續(xù)心輸出量測量法(PICCO)的臨床和實驗研究。本研究
通過動物實驗比較經(jīng)肺熱稀釋法和肺動脈導管法測量血流動
力學參數(shù),進一步評估 PICCO的準確性和臨床應用價值。
1 材料與方法
1. 1 材料 雜種犬20只 ,雌雄不拘 ,體質量(20 ±2) kg ,由北
京協(xié)和醫(yī)院動物實驗中心提供。
1. 2 失血性休克動物模型建立 雜種犬稱質量后 ,給予 3 %
戊巴比妥15～20 mg/ kg肌肉注射 ,2 %利多卡因局部麻醉行
氣管切開 ,置入直徑 7. 5 mm的氣管導管 ,接 Taema 呼吸機 ,容量控制通氣 ,潮氣量15 mL/ kg ,呼吸頻率15次/ min ,吸入氧
濃度(FiO2) 50 %;呼氣末正壓(PEEP) 0 cm H2O。右頸內靜脈
置入肺動脈漂浮導管 ,監(jiān)測肺動脈楔壓(PAWP) ,左頸內靜脈
置入深靜脈管測中心靜脈壓(CVP) ,右股動脈置入 PICCO導
管監(jiān)測有創(chuàng)動脈壓 ,同時監(jiān)測持續(xù)輸出量(CCO) ,左側股靜脈
置管備用放血 ,30 min內放血容量占總血容量的 43 %[ (34 ±
2)mL/ kg] ,使平均動脈壓(MAP)穩(wěn)定維持在45～55 mm Hg 45
min ,視為休克模型成功 ,進入實驗 ......
齊志偉 , 王 仲 , 徐 軍 , 梁 璐 , 朱華棟 , 李 毅 , 于學忠 , 馬 遂
[作者單位] 中國協(xié)和醫(yī)科大學中國醫(yī)學科學院北京協(xié)和醫(yī)院急診
科,北京 100730
[作者簡介] 齊志偉(1975 - ) ,男,住院醫(yī)師,博士研究生,急診醫(yī)學
專業(yè)。
[摘 要] 目的 比較經(jīng)肺熱稀釋法和肺動脈導管法測量血流動力學參數(shù)。方法 通過經(jīng)肺熱稀釋法(COa) 、右心漂浮
導管熱稀釋法(COpa)和脈搏誘導持續(xù)心輸出量測量法(COpc)在 20 只犬失血性休克模型制作前后以及應用不同液體容量復
蘇后測量心輸出量和血液動力學參數(shù) ,比較 COa、 COpa、 COpc之間的關系。并且比較經(jīng)肺熱稀釋法、右心漂浮導管熱稀釋法兩
種方法測得的血液動力學參數(shù)(包括 SVRI和 SVI ) 。結果 實驗全程中 COpc、 COa 和 COpc 的相關性好 ,準確性很穩(wěn)定。體循
環(huán)指數(shù)(SVRI)和每搏輸出量指數(shù)(SVI )在經(jīng)肺熱稀釋法和右心漂浮導管熱稀釋法比較中呈正相關。結論 在犬失血性休克模
型中 ,我們發(fā)現(xiàn)與肺動脈導管法相比較 ,經(jīng)肺熱稀釋法測量得到的血流動力學參數(shù)準確穩(wěn)定 ,COpc 準確、可靠 ,體循環(huán)指數(shù)
(SVRI)和每搏輸出量(SVI )在兩種方法中的相關性良好。
[關鍵詞] 脈搏誘導的持續(xù)心輸出量; 失血性休克; 肺動脈導管法; 體循環(huán)指數(shù); 每搏輸出量指數(shù)
[中圖分類號] [文獻標識碼] A [文章編號] 1002 - 1949(2006) 06 - 0439 - 03
Comparison of two kinds of thermodilution methods for the values of hemodynamic Variables in hemorrhaged shock models of dog
QI Zhi - wei , WANG Zhong , XU Jun , et al . Department of Emergency , Peking Union Medical College Hospital , Peking Union Medical Col2
lege , Chinese Academy of Medical Sciences , Beijing 100730 , China
[ Abstract] Objective ①To compare two thermodilution methods for the values of hemodynamic Variables , including cardiac output
(CO) thermodilution in the pulmonary artery (COpa) and thermodilution in the femoral artery (COa) with each other and with CO determined
by continuous pulse contour analysis (COpc) ; to evaluate the accuracy of CO by PICCO. ②To compare the difference of systemic vascular re 2
sistance index(SVRI) and stroke volume index(SVI) between these two methods. Methods In 20 dogs with hemorrhaged shock , hemody 2
namic parameters were evaluated by the 2 kinds of transpulmonary thermodilution technique including Swan - Ganz catheter and pulse induced
continuous cardiac output (PICCO) , before and after hemorrhaged shock , and after volume resuscitation. To compare COa ,COpa ,COpc , and
compare the difference of SVRI and SVI between these two methods. Result Through all the study , correlation and precision of COpc , COpa
vs. COa was stable. SVRI and SVI by these two kinds of thermodilution techniques are correlated. Conclusion In dog models with hemor2
rhaged shock , our findings demonstrate that there are no statistic differences of hemodynamic parameters between by the pulmonary artery ther 2
modilution and by the femoral artery thermodilution. Femoral artery pulse contour CO correlates well with both COpa and COa. SVRI and SVI
also correlate well in these two kinds of thermodilution techniques.
[ Key word] Pulse induced continuous cardiac output ; Pulmonary artery catheter ; Hemorrhaged shock ; Systemic vascular resis2
tance index ; Stroke volume index
臨床醫(yī)師一直在努力尋找能夠反映血流動力學指標的良
好監(jiān)測方法[1]
,既要準確同時還要創(chuàng)傷小。多年來,臨床上較
多應用右心漂浮導管法,該法有一定潛在的并發(fā)癥[2]
,并且其
準確性受到機械通氣的影響。近來,開始出現(xiàn)了對經(jīng)脈搏誘
導持續(xù)心輸出量測量法(PICCO)的臨床和實驗研究。本研究
通過動物實驗比較經(jīng)肺熱稀釋法和肺動脈導管法測量血流動
力學參數(shù),進一步評估 PICCO的準確性和臨床應用價值。
1 材料與方法
1. 1 材料 雜種犬20只 ,雌雄不拘 ,體質量(20 ±2) kg ,由北
京協(xié)和醫(yī)院動物實驗中心提供。
1. 2 失血性休克動物模型建立 雜種犬稱質量后 ,給予 3 %
戊巴比妥15～20 mg/ kg肌肉注射 ,2 %利多卡因局部麻醉行
氣管切開 ,置入直徑 7. 5 mm的氣管導管 ,接 Taema 呼吸機 ,容量控制通氣 ,潮氣量15 mL/ kg ,呼吸頻率15次/ min ,吸入氧
濃度(FiO2) 50 %;呼氣末正壓(PEEP) 0 cm H2O。右頸內靜脈
置入肺動脈漂浮導管 ,監(jiān)測肺動脈楔壓(PAWP) ,左頸內靜脈
置入深靜脈管測中心靜脈壓(CVP) ,右股動脈置入 PICCO導
管監(jiān)測有創(chuàng)動脈壓 ,同時監(jiān)測持續(xù)輸出量(CCO) ,左側股靜脈
置管備用放血 ,30 min內放血容量占總血容量的 43 %[ (34 ±
2)mL/ kg] ,使平均動脈壓(MAP)穩(wěn)定維持在45～55 mm Hg 45
min ,視為休克模型成功 ,進入實驗 ......
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