两种热稀释法测量血流动力学参数在犬失血性休克模型中的比较

    齐志伟 , 王 仲 , 徐 军 , 梁 璐 , 朱华栋 , 李 毅 , 于学忠 , 马 遂

    [作者单位] 中国协和医科大学中国医学科学院北京协和医院急诊

    科,北京 100730

    [作者简介] 齐志伟(1975 - ) ,男,住院医师,博士研究生,急诊医学

    专业。

    [摘 要] 目的 比较经肺热稀释法和肺动脉导管法测量血流动力学参数。方法 通过经肺热稀释法(COa) 、右心漂浮

    导管热稀释法(COpa)和脉搏诱导持续心输出量测量法(COpc)在 20 只犬失血性休克模型制作前后以及应用不同液体容量复

    苏后测量心输出量和血液动力学参数 ,比较 COa、 COpa、 COpc之间的关系。并且比较经肺热稀释法、右心漂浮导管热稀释法两

    种方法测得的血液动力学参数(包括 SVRI和 SVI ) 。结果 实验全程中 COpc、 COa 和 COpc 的相关性好 ,准确性很稳定。体循

    环指数(SVRI)和每搏输出量指数(SVI )在经肺热稀释法和右心漂浮导管热稀释法比较中呈正相关。结论 在犬失血性休克模

    型中 ,我们发现与肺动脉导管法相比较 ,经肺热稀释法测量得到的血流动力学参数准确稳定 ,COpc 准确、可靠 ,体循环指数

    (SVRI)和每搏输出量(SVI )在两种方法中的相关性良好。

    [关键词] 脉搏诱导的持续心输出量; 失血性休克; 肺动脉导管法; 体循环指数; 每搏输出量指数

    [中图分类号] [文献标识码] A [文章编号] 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

    临床医师一直在努力寻找能够反映血流动力学指标的良

    好监测方法[1]

    ,既要准确同时还要创伤小。多年来,临床上较

    多应用右心漂浮导管法,该法有一定潜在的并发症[2]

    ,并且其

    准确性受到机械通气的影响。近来,开始出现了对经脉搏诱

    导持续心输出量测量法(PICCO)的临床和实验研究。本研究

    通过动物实验比较经肺热稀释法和肺动脉导管法测量血流动

    力学参数,进一步评估 PICCO的准确性和临床应用价值。

    1 材料与方法

    1. 1 材料 杂种犬20只 ,雌雄不拘 ,体质量(20 ±2) kg ,由北

    京协和医院动物实验中心提供。

    1. 2 失血性休克动物模型建立 杂种犬称质量后 ,给予 3 %

    戊巴比妥15～20 mg/ kg肌肉注射 ,2 %利多卡因局部麻醉行

    气管切开 ,置入直径 7. 5 mm的气管导管 ,接 Taema 呼吸机 ,容量控制通气 ,潮气量15 mL/ kg ,呼吸频率15次/ min ,吸入氧

    浓度(FiO2) 50 %;呼气末正压(PEEP) 0 cm H2O。右颈内静脉

    置入肺动脉漂浮导管 ,监测肺动脉楔压(PAWP) ,左颈内静脉

    置入深静脉管测中心静脉压(CVP) ,右股动脉置入 PICCO导

    管监测有创动脉压 ,同时监测持续输出量(CCO) ,左侧股静脉

    置管备用放血 ,30 min内放血容量占总血容量的 43 %[ (34 ±

    2)mL/ kg] ,使平均动脉压(MAP)稳定维持在45～55 mm Hg 45

    min ,视为休克模型成功 ,进入实验 ......