| BackgroundAccording to the 9th edition of IDF(International Diabetes Federation)diabetes Atlas,the global prevalence of diabetes is increasing rapidly.China has the largest number of patients with diabetes,including 35 million elderly people,making diabetes a great challenge to country.The long-term hyperglycemia stimulation leads to the abnormal myocardial structure and function,and manifested as cardiac hypertrophy and diastolic dysfunction.In the perioperative,patients are suffered from the stress response from surgery and anesthesia,it increases the risks of tissue ischemia;therefore,hemodynamic monitoring is of great clinical value.FloTrac TM-Vigileo TM has been widely used in the clinical,while the accuracy and sensitivity of NICOMTM in patients with diabetes are not clear.Materials and methodsPatients with diabetes were monitored by NICOM TM and FloTracTM-VigileoTM.The main parameters included SVI(stroke volume index),CI(cardiac index).The collection time points:before anesthesia induction(T0),10 min(T1),30 min(T2),60 min(T3),and 90 min(T4),and 120 min(T5)after endotracheal intubation respectively,10 min before the end of surgery(T6).The fluid challenge test was performed before the operation,and values of SVI before the test and 10 minutes after the test were recordedThe hemodynamic data were analyzed by SPSS-20 and MedCalc.Pearson correlation analysis and Bland-Altman analysis were performed on continuous data(SVI,CI)in NICOM group and FloTrac group.Another diagnostic test besides comparing the capabilities of predicting fluid responsiveness in two devices,by the ROC curve and Cohen’s kappa coefficient analysis.ResultsA total of 40 surgical patients were included in the study,among 3 patients were excluded.General clinical information of 37 patients,258 sets of SVI data,247 sets of CI data and 31 sets of fluid responsiveness test were collected.Pearson correlation analysis showed that the SVI had weak correlation and CI had moderate correlation measured by the two devices.In the Bland-Altman analysis of SVI,96.12%of the points were within the 95%limit of agreement,3.88%of the points were outside the 95%limit of agreement,and the percentage error was less than 30%,it indicated that the bias of SVI was statistically acceptable.In the Bland-Altman analysis of CI,96.36%of the points were within the 95%limit of agreement,3.64%of the points were outside the 95%limit of agreement,and the percentage error was less than 30%,so the bias of CI was statistically acceptable.the SVI of patients increase by 10%as having fluid responsiveness.the ROC curve of NICOM TM shows the area under the ROC curve is 0.79,95%confidence limit was(0.60,0.91),P<0.05,there is no significant difference,it is concluded that the diagnostic capacity of NICOM TM is close to the FloTracTM-Vigileo TM.To further measure the agreement,Cohen’s kappa coefficient analysis was used in this study,it shows kappa=0.56,95%confidence limit is(0.25,0.87),P<0.05,this result indicating that the two devices had a moderate consistency to predict fluid responsiveness.Concludes1、In patients with diabetes,the agreement of SVI and CI measured by NICOMTM and FloTracTM-VigileoTM are good.2、Compared with FloTrac TM-VigileoTM,NICOMTM shows acceptable accuracy and similar sensitive for predicting fluid responsiveness. |
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