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中心静脉氧饱和度替代混合静脉氧饱和度对先天性心脏病合并肺动脉高压术后的监护价值:多中心前瞻性研究

胡帅 韩志岩 王晓建 韩京军 伍德强 张磊 林焰桂 梁建文 魏文斌 张文林 母存富 王义 李巅远

胡帅, 韩志岩, 王晓建, 韩京军, 伍德强, 张磊, 林焰桂, 梁建文, 魏文斌, 张文林, 母存富, 王义, 李巅远. 中心静脉氧饱和度替代混合静脉氧饱和度对先天性心脏病合并肺动脉高压术后的监护价值:多中心前瞻性研究[J]. 协和医学杂志, 2018, 9(3): 228-233. doi: 10.3969/j.issn.1674-9081.2018.03.008
引用本文: 胡帅, 韩志岩, 王晓建, 韩京军, 伍德强, 张磊, 林焰桂, 梁建文, 魏文斌, 张文林, 母存富, 王义, 李巅远. 中心静脉氧饱和度替代混合静脉氧饱和度对先天性心脏病合并肺动脉高压术后的监护价值:多中心前瞻性研究[J]. 协和医学杂志, 2018, 9(3): 228-233. doi: 10.3969/j.issn.1674-9081.2018.03.008
Shuai HU, Zhi-yan HAN, Xiao-jian WANG, Jing-jun HAN, De-qiang WU, Lei ZHANG, Yan-gui LIN, Jian-wen LIANG, Wen-bin WEI, Wen-lin ZHANG, Cun-fu MU, Yi WANG, Dian-yuan LI. Monitoring Value of Central Venous Oxygen Saturation, the Substitute for Mixed Venous Oxygen Saturation, in Postoperative Care of Congenital Heart Disease with Pulmonary Arterial Hypertension:a Multicenter Prospective Study[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(3): 228-233. doi: 10.3969/j.issn.1674-9081.2018.03.008
Citation: Shuai HU, Zhi-yan HAN, Xiao-jian WANG, Jing-jun HAN, De-qiang WU, Lei ZHANG, Yan-gui LIN, Jian-wen LIANG, Wen-bin WEI, Wen-lin ZHANG, Cun-fu MU, Yi WANG, Dian-yuan LI. Monitoring Value of Central Venous Oxygen Saturation, the Substitute for Mixed Venous Oxygen Saturation, in Postoperative Care of Congenital Heart Disease with Pulmonary Arterial Hypertension:a Multicenter Prospective Study[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(3): 228-233. doi: 10.3969/j.issn.1674-9081.2018.03.008

中心静脉氧饱和度替代混合静脉氧饱和度对先天性心脏病合并肺动脉高压术后的监护价值:多中心前瞻性研究

doi: 10.3969/j.issn.1674-9081.2018.03.008
基金项目: 

深圳市医疗卫生三名工程项目 SZSM201502001

详细信息
    通讯作者:

    李巅远 电话:755-83982222-32276, E-mail:drdianyuanli@163.com

  • 中图分类号: R654.2;R473.6

Monitoring Value of Central Venous Oxygen Saturation, the Substitute for Mixed Venous Oxygen Saturation, in Postoperative Care of Congenital Heart Disease with Pulmonary Arterial Hypertension:a Multicenter Prospective Study

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  • 摘要:   目的  探讨中心静脉氧饱和度(central venous oxygen saturation, ScvO2)与混合静脉氧饱和度(mixed venous oxygen saturation, SvO2)对先天性心脏病(congenital heart disease, CHD)合并肺动脉高压(pulmonary arterial hypertension, PAH)患者修补术后评估价值的一致性。   方法  本研究前瞻性选取2016年3月至2017年3月, 于河南省人民医院、北京阜外医院、广州中山大学第八附属医院及四川省广元市第一人民医院接受治疗且符合入选及排除标准的43例CHD-PAH患者, 分别于停体外循环后即刻及转入重症监护室后6、12、24、48 h等5个时间点, 同时测量ScvO2及SvO2, 并记录血流动力学参数、血红蛋白及乳酸等指标。采用Bland-Altman检验分析两个指标的一致性, 采用线性回归分析两指标偏倚的相关影响因素。   结果   ScvO2和SvO2的总体相关系数R2=0.369, 体外循环后即刻R2=0.515, 入重症监护室后6、12、24、48 h的R2分别为0.375、0.605、0.712、0.252。Bland-Altman检验显示ScvO2与SvO2的偏倚(△ScvO2﹣SvO2)为-1.3%, 一致性区间(limits of agreement, LOA)为(-17.0%, 14.4%)。总体上氧摄取率(oxygen extraction rate, O2ER)(R2=0.030, P < 0.05)、肺动脉收缩压(R2=0.030, P < 0.05)和心率(R2=0.032, P < 0.05)对△ScvO2-SvO2的影响较小; 当ScvO2 < 70%时, O2ER(R2=0.203, P < 0.01)、肺动脉收缩压(R2=0.110, P < 0.01)、心率(R2=0.150, P < 0.01)对△ScvO2-SvO2的影响则较大, 此时ScvO2有低估SvO2的趋势, 而当ScvO2 ≥ 70%时, ScvO2会高估SvO2。机械通气期间ScvO2与SvO2的偏倚为-1.3%, LOA为(-16.1%, 13.5%), △ScvO2-SvO2的影响因素为O2ER(R2=0.122, P < 0.01);撤机后ScvO2与SvO2的偏倚为-1.3%, LOA为(-19.5%, 16.8%), △ScvO2-SvO2的影响因素为O2ER(R2=0.320, P < 0.01)和动脉氧饱和度(R2=0.320, P < 0.01)。   结论   CHD-PAH患者术后监护中ScvO2不能替代SvO2的评估价值。当ScvO2 ≥ 70%时, 宜同时监测ScvO2与SvO2以排除低灌注状态。
  • 图  1  CHD-PAH患者术后48 h内各监测时间点的ScvO2和SvO2

    CHD:先天性心脏病; PAH:肺动脉高压; ScvO2:中心静脉氧饱和度; SvO2:混合静脉氧饱和度

    图  2  Bland-Altman检验分析CHD-PAH患者术后各监测时间点ScvO2与SvO2的一致性

    CHD、PAH、ScvO2、SvO2:同图 1

    图  3  回归分析CHD-PAH患者术后全时间检测点ScvO2和SvO2的一致性

    CHD、PAH、ScvO2、SvO2:同图 1

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  • 收稿日期:  2018-03-11
  • 刊出日期:  2018-05-30

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