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

徐梦茹; 刘旺林; 何怀武; 赖晓丽; 赵美玲; 刘大为; 隆云

doi:10.24920/004158

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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

中国医学科学杂志（英文） 2023年38卷第2期页码：117-124

Original article | Updated：2024-06-12

- 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
- Affiliations：
  
  1. 1Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
  2. 2Department of Critical Care Medicine, Beihai People's Hosptial, Beihai 536000, Guangxi Zhuang Autonomous Region, China
  3. 3Department of Critical Care Medicine, Zibo Central Hospital, Medical College of Shandong University, Zibo 255020, Shandong Province, China
- Author bio：
  
  *Huai-Wu He, E-mail: tjmuhhw@126.com.
- Funds：
- DOI：10.24920/004158
  中图分类号：
- 收稿日期：2022-08-23，
  
  录用日期：2023-03-20，
  
  网络出版日期：2023-04-13，
  
  纸质出版日期：2023-06-30
- Accepted：
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徐梦茹, 刘旺林, 何怀武, 等. 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[J]. 中国医学科学杂志（英文）, 2023,38(2):117-124.

Meng-Ru Xu, Wang-Lin Liu, Huai-Wu He, et al. 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.
徐梦茹, 刘旺林, 何怀武, 等. 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[J]. 中国医学科学杂志（英文）, 2023,38(2):117-124. DOI： 10.24920/004158.

Meng-Ru Xu, Wang-Lin Liu, Huai-Wu He, et al. 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. DOI： 10.24920/004158.

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。

方法

2 mmHg者分为一致组。

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（

= 0.283，

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。

Abstract

Background

A simple meas

urement 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)

.5.24(2.18)

0.001

]

than that in the consistent group. There was a significantly positive relationship between ΔCVP and |CVP-mean - CVP-end| (

=0.283

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 meas

urement) 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.

关键词

Keywords

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