2020 年第 5 期 第 15 卷

脉搏指示连续心输出量监测和无创胸阻抗法监测与经胸超声心动图法测量老年重症心力衰竭患者心功能指标的相关性

Relation among pulse indicator continuous cardiac output, non-invasive thoracic electrical bioimpedance and transthoracic echocardiography evaluating cardiac function in elderly patients with severe heart failure

作者：祁莉萍刘宏伟洪昌明白永怿李昂

英文作者：Qi Liping Liu Hongwei Hong Changming Bai Yongyi Li Ang

单位：国家老年疾病临床医学研究中心解放军总医院第二医学中心心内科，北京100853

英文单位：National Center for Clinical Medicine of Geriatric Diseases Department of Cardiology the Second Clinical Center Chinese PLA General Hospital Beijing 100853 China

关键词：心力衰竭；心功能；脉搏指示连续心输出量；胸阻抗；经胸超声心动图

英文关键词：Heartfailure;Cardiacfunction;Pulseindicatorcontinuouscardiacoutput;Thoracicelectricalbioimpedance;Transthoracicechocardiography 

• 摘要：

• 目的 探讨脉搏指示连续心输出量（PiCCO）监测和无创胸阻抗法监测与经胸超声心动图（TTE）法测量老年重症心力衰竭患者心功能指标的相关性。方法 选择2016年1月至2019年1月解放军总医院第二医学中心心内科监护室住院治疗的老年重症心力衰竭患者共45例。分别用PiCCO、无创胸阻抗法、TTE检测患者心功能，其中PiCCO监测包括心排血指数（CI）、全心舒张末期容积指数、血管外肺水指数、外周血管阻力指数等。无创胸阻抗法测量心输出量、外周血管阻力(SVR)、加速指数和胸部液体含量(TFC)等。统一行TTE测量，所有患者检测N末端B型脑钠肽前体（NT-proBNP）水平。分析几种方法 相关指标的相关性。结果 45例患者NT-proBNP 3 276.5（1 591.5，11 372.5）ng/L，超声左心室射血分数（LVEF）（44±8）%。Pearson 相关分析结果显示PiCCO指标中CI与TTE的LVEF相关（r=0.885，P=0.022）。PiCCO指标中CI与胸阻抗无创指标TFC相关（r=0.683，P=0.005），中心静脉压（CVP）与胸阻抗无创指标SVR相关（r=0.346，P=0.045），平均动脉压与胸阻抗无创指标收缩时间比率（STR）、预射血期相关（r=0.448，P=0.008；r=0.683，P<0.001）。多因素分析显示左心室射血时间与PiCCO指标中平均动脉压呈正相关（P=0.022），与CVP呈负相关（P=0.002），与胸阻抗法测量指标中TFC呈正相关（P=0.011）；NT-proBNP 与PiCCO法测量指标中CVP呈正相关（P=0.025）。胸阻抗无创指标CI、心输出量与NT-proBNP呈负相关（P=0.007、0.006），TFC、STR与NT-proBNP呈正相关（P=0.044、0.049）。结论老年重症心力衰竭患者PiCCO监测指标与NT-proBNP水平及TTE评价的心功能指标相关，胸阻抗监测指标与NT-proBNP水平及TTE评价的心功能指标相关，无创胸阻抗法可以作为PiCCO的替代方法 评估心功能。

• Objective To investigate the relation among pulse indicator continuous cardiac output(PiCCO), non-invasive thoracic electrical bioimpedance(TEB) and transthoracic echocardiography(TTE) evaluating cardiac function in elderly patients with severe heart failure. Methods Forty-five elderly patients with severe heart failure were enrolled from January 2016 to January 2019 in the Second Clinical Center, Chinese PLA General Hospital. PiCCO was used to measure cardiac index(CI), global end-diastolic volume index, extravascular lung water index and systemic vascular resistance. TEB was used to measure cardiac output, systemic vascular resistance(SVR), acceleration index and thoracic fluid content(TFC). TTE was performed and serum level of N-terminal pro-brain natriuretic peptide(NT-proBNP) was detected. Results The median value of NT-proBNP was 3 276.5（1 591.5, 11 372.5）ng/L. The mean value of left ventricular ejection fraction(LVEF) measured by TTE was (44±8)%. Pearson analysis showed that CI was correlated with LVEF（r=0.885, P=0.022） and TFC（r=0.683, P=0.005）;central venous pressure(CVP) measured by PiCCO was correlated with SVR（r=0.346， P=0.045）;mean arterial pressure(MAP) measured by PiCCO was correlated with shrinkage time ratio(STR) and pre-ejection phase measured by TEB（r=0.448, P=0.008； r=0.683, P＜0.001）. Multivariate regression analysis showed that LVEF was positively correlated with MAP（P=0.022）, negatively correlated with CVP（P=0.002）, positively correlated with TFC（P=0.011）; NT-proBNP was positively correlated with CVP(P=0.025), negatively correlated with CI and cardiac output(P=0.007, 0.006), positively correlated with TFC and STR(P=0.044, 0.049). Conclusions Monitoring indexes of PiCCO and TEB are related with NT-proBNP level and cardiac function measured by TTE. Non-invasive TEB can be used as an alternative method of PiCCO to evaluate the cardiac function in elderly patients with severe heart failure.