Gründeman P F, Borst C, Verlaan C W, Damen S, Mertens S
Heart Lung Center Utrecht, University Medical Center, The Netherlands.
Ann Thorac Surg. 2001 Dec;72(6):1991-6. doi: 10.1016/s0003-4975(01)03093-4.
In beating-heart coronary surgical procedures, exposure of posterior vessels through sternotomy causes cardiac function to deteriorate. We hypothesized that turning the subject to the right lateral decubitus position before cardiac retraction improves exposure of posterior vessels and preserves cardiac pump function on displacement.
Eight 80-kg open-chest pigs were instrumented with catheter-tip manometers. After a stepwise 60-degree turn to the right lateral decubitus position of the body, the heart was retracted anteriorly to 90 degrees with a suction stabilizer.
Right lateral body positioning caused an approximately 45-degree right deviation of the apex, thereby exposing the left atrial groove. Stroke volume, mean arterial pressure, right atrial pressure, and right ventricular end-diastolic pressure increased to 106% +/- 5% (mean +/- standard error of the mean, p = 0.31), 106% +/- 3% (p = 0.01), 129% +/- 8% (p = 0.001), and 171% +/- 14% (p = 0.002), respectively, compared with control values. In contrast, left atrial pressure decreased to 73% +/- 6% (p = 0.007), whereas left ventricular preload remained unchanged (110% +/- 8%, p = 0.26). Additional anterior displacement to 90 degrees fully exposed the posterior vessels, and stroke volume decreased to 90% +/- 3% (p = 0.01) and mean arterial pressure to 93% +/- 5% (p = 0.07) at the expense of further increased right ventricular preload (256% +/- 28%, p < 0.001).
By placing the subject in the right lateral decubitus position, exposure through sternotomy of posterior vessels in the beating porcine heart was facilitated while mean arterial pressure was maintained.
在心脏跳动的冠状动脉手术过程中，通过胸骨切开术暴露后方血管会导致心脏功能恶化。我们假设在心脏牵拉前将受试者转为右侧卧位可改善后方血管的暴露，并在移位时保留心脏泵功能。
八只80千克的开胸猪被植入导管尖端压力计。在身体逐步向右侧卧位转动60度后，用吸引稳定器将心脏向前牵拉至90度。
身体右侧卧位导致心尖向右偏移约45度，从而暴露左心房沟。与对照值相比，每搏输出量、平均动脉压、右心房压力和右心室舒张末期压力分别增加至106%±5%（平均值±平均值的标准误差，p = 0.31）、106%±3%（p = 0.01）、129%±8%（p = 0.001）和171%±14%（p = 0.002）。相比之下，左心房压力降至73%±6%（p = 0.007），而左心室前负荷保持不变（110%±8%，p = 0.26）。进一步向前移位至90度可充分暴露后方血管，每搏输出量降至90%±3%（p = 0.01），平均动脉压降至93%±5%（p = 0.07），代价是右心室前负荷进一步增加（256%±28%，p < 0.001）。
通过将受试者置于右侧卧位，在维持平均动脉压的同时，便于经胸骨切开术暴露跳动猪心脏的后方血管。
