Порівняння методів визначення хвилинного об’єму крові в пацієнтів із легеневою гіпертензією
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https://orcid.org/0009-0000-8851-3115
Анотація
Мета роботи – оцінити та порівняти величину хвилинного об’єму крові (ХОК), визначеного різними методами (термодилюція, прямий та непрямий методи Фіка), у пацієнтів з легеневою гіпертензією (ЛГ).
Матеріали і методи. У дослідження залучено 57 пацієнтів із різними формами ЛГ, яким проведено катетеризацію правих відділів серця (КПС) за стандартним протоколом. Порівняльний аналіз ХОК проводився у три етапи: зіставлення термодилюції (ТД) із непрямим методом Фіка (НФ) (n = 45), НФ з прямим методом Фіка (ПФ) (n = 23) та ТД із ПФ (n = 12). Сформовані групи були статистично зіставними за антропометричними даними (зріст, вік, маса тіла, індекс маси тіла, стать – ANOVA, p > 0,05). Пряме споживання кисню (V̇O2) визначали методом непрямої респіраторної калориметрії.
Результати. НФ суттєво занижує показники серцевого викиду порівняно з термодилюцією (на 38 %, p < 0,001). Аналіз узгодженості підтвердив критично високу похибку відтворення результатів НФ (88,5–119,9 % за Крітчлі). При порівнянні ТД та ПФ виявлено статистично значущу залежність помилки від величини серцевого викиду (β1 = 0,79; p = 0,029; R2 = 0,392), з абсолютним зміщенням 0,69 л/хв та відносним (8,47 ± 43,91) %. При значеннях ХОК понад 7,37 л/хв спостерігається стрімке зростання розбіжностей між методами, що свідчить про обмеження точності ТД у пацієнтів із високим серцевим викидом та необхідність верифікації даних.
Висновки. ХОК, визначений НФ, статистично значущо відрізняється від величини ХОК, визначеної методом ТД або методом ПФ. Якщо при оцінці методом ТД величина ХОК перевищує поріг 7,37 л/хв, то таким пацієнтам для отримання статистично значущої оцінки гемодинамічного статусу необхідно визначати ХОК саме прямим методом Фіка.
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