监护仪显示中心静脉压平均值的准确性：呼吸对中心静脉压振幅的影响

doi:10.24920/004158

摘要/Abstract

摘要：

背景用数字显示器简单测量中心静脉压（CVP）均值的方法越来越流行。然而，CVPmean和CVPend（一种通过分析截止时的波形来测量CVP的标准方法）之间的一致性并无定论。本研究旨在确定危重患者CVPmean与CVPend的关系，并引入一个新的呼吸期CVP振幅参数ΔCVP（ΔCVP= CVPmax - CVPmin）以识别CVPmean与CVPend之间的一致性或不一致性。

结果与一致性组相比，ΔCVP在一致性组中显著增加[7.17±2.77）vs. 5.24±2.18，P<0.001）。ΔCVP与|CVP-mean - CVP-end|呈显著正相关（r = 0.283，P < 0.0001）。Bland和Altman图显示偏差为-0.61 mmHg, CVPend和CVPmean的95%限度一致（-3.34，2.10）。预测|CVPmean - CVPend|≥2 mmHg的受试者工作特征曲线ΔCVP下面积为0.709。CVP < 3 mmHg检测|CVPmean -CVPend| < 2 mmHg（一致性测量）具有较高的诊断特异性，灵敏度为22.37%，特异性为93.06%。使用CVP > 8 mmHg检测|CVPmean - CVPend| > 8 mmHg（测量不一致），灵敏度为31.94%，特异性为91.32%。

结论不同方法的CVPend和CVPmean在临床上存在显著差异。ΔCVP与两种CVP方法的变化有关。较高的ΔCVP表明两种方法之间的一致性很差，而较低的ΔCVP表明两种方法之间具有良好的一致性。

关键词: 中心静脉压, 监护仪数字显示器, 监护仪光标线显示器, 呼吸

Abstract:

Background A simple measurement of central venous pressure (CVP)-mean by the digital monitor display has become increasingly popular. However, the agreement between CVP-mean and CVP-end (a standard method of CVP measurement by analyzing the waveform at end-expiration) is not well determined. This study was designed to identify the relationship between CVP-mean and CVP-end in critically ill patients and to introduce a new parameter of CVP amplitude (ΔCVP= CVPmax - CVPmin) during the respiratory period to identify the agreement/disagreement between CVP-mean and CVP-end.

Methods In total, 291 patients were included in the study. CVP-mean and CVP-end were obtained simultaneously from each patient. CVP measurement difference (|CVP-mean - CVP-end|) was defined as the difference between CVP-mean and CVP-end. The ΔCVP was calculated as the difference between the peak (CVPmax) and the nadir value (CVPmin) during the respiratory cycle, which was automatically recorded on the monitor screen. Subjects with |CVP-mean - CVP-end|≥ 2 mmHg were divided into the inconsistent group, while subjects with |CVP-mean - CVP-end| < 2 mmHg were divided into the consistent group.

Results ΔCVP was significantly higher in the inconsistent group [7.17(2.77) vs.5.24(2.18), P<0.001] than that in the consistent group. There was a significantly positive relationship between ΔCVP and |CVP-mean - CVP-end| (r=0.283, P <0.0001). Bland-Altman plot showed the bias was -0.61 mmHg with a wide 95% limit of agreement (-3.34, 2.10) of CVP-end and CVP-mean. The area under the receiver operating characteristic curves (AUC) of ΔCVP for predicting |CVP-mean - CVP-end| ≥ 2 mmHg was 0.709. With a high diagnostic specificity, using ΔCVP<3 to detect |CVP-mean - CVP-end| lower than 2mmHg (consistent measurement) resulted in a sensitivity of 22.37% and a specificity of 93.06%. Using ΔCVP>8 to detect |CVP-mean - CVP-end| >8 mmHg (inconsistent measurement) resulted in a sensitivity of 31.94% and a specificity of 91.32%.

Conclusions CVP-end and CVP-mean have statistical discrepancies in specific clinical scenarios. ΔCVP during the respiratory period is related to the variation of the two CVP methods. A high ΔCVP indicates a poor agreement between these two methods, whereas a low ΔCVP indicates a good agreement between these two methods.

Key words: central venous pressure, monitor digital display, monitor cursor-line display, respiration

Meng-Ru Xu, Wang-Lin Liu, Huai-Wu He, Xiao-Li Lai, Mei-Ling Zhao, Da-Wei Liu, Yun Long. Accuracy of Mean Value of Central Venous Pressure from Monitor Digital Display: Influence of Amplitude of Central Venous Pressure during Respiration[J].Chinese Medical Sciences Journal, 2023, 38(2): 117-124.

图/表 8

参考文献 22

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Parameters	Total
Age (years)	57.32 ± 16.18
Sex (male/female)	159/132
Heart rate (bpm)	92 ± 18
Mean arterial pressure (mmHg)	90 ± 14
CVP-mean (mmHg)	7.69 ± 3.10
CVP-end (mmHg)	8.26 ± 3.23
\|CVP-mean-CVP-end\| (mmHg)	1.03 ± 0.87
CVPmax (mmHg)	11.07 ± 3.58
CVPmin (mmHg)	5.36 ± 3.12
CVPmax-CVPmin (mmHg)	5.71 ± 2.48

Parameters	Inconsistent group (n=72)	Consistent group (n=219)	Statistics	P value
Age (years)	56.44 ± 15.87	57.68 ± 16.33	t = 0.30	0.544
HR (bpm)	93 ± 18	92 ± 18	t = 0.13	0.961
MAP (mmHg)	89 ± 13	90 ± 14	t = 0.51	0.773
Pts with/without spontaneous breath	59/13	146/73	χ² = 5.4	0.014*
CVP-mean (mmHg)	7.72 ± 4.05	7.67 ± 2.74	t = 0.15	0.787
CVP-end (mmHg)	9.38 ± 4.16	7.90 ± 2.78	t = 3.41	0.004*
\|CVP-mean-CVP-end\|(mmHg)	2.25 ± 0.63	0.635 ± 0.48	t = 22.92	<0.0001*
CVPmax (mmHg)	12.04 ± 4.39	10.75 ± 3.22	t = 2.67	0.014*
CVPmin (mmHg)	4.88 ± 4.05	5.52 ± 2.75	t = 1.51	0.196
CVPmax-CVPmin (mmHg)	7.17 ± 2.77	5.24 ± 2.18	t = 6.07	<0.0001*

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