Austin S M, Schreiner B F, Shah P M, Yu P N
Circulation. 1976 Feb;53(2):356-63. doi: 10.1161/01.cir.53.2.356.
The acute hemodynamic effects of supine leg exercise or atrial pacing were studied in 114 patients undergoing right and either transseptal (87 cases) or retrograde (27 cases) left heart catheterization. Seventy-one patients - 15 with coronary artery disease, 22 with aortic valve disease, and 34 with mitral valve disease - performed exercise on a bicylce ergometer. Forty-three patients, of whom 22 had coronary artery disease, nine aortic valve disease and 12 mitral valve disease, were studied during rapid atrial pacing. Cardiac index (CI), pulmonary artery mean (PAm), and left atrial mean (LAm) pressure, pulmonary blood volume (PBV) and pulmonary extravascular volume (PEV) were measured during the control state and during acute intervention. Both exercise and pacing resulted in significant elevations in PAm (range 37-65%) and LAm (range 36-43%) mean pressures in all patients. Cardiac index rose between 34 and 58% in the exercise groups, but did not change in those who were paced. During intervention both PBV and PEV increased significantly in all but the nine patients with aortic valve disease who were paced. Although volume increased occurred, they did not achieve the 5% significanc- level. For all patients the mean increment in PBV ranged between 37 and 123 ml/m2 over control, while PEV rose between 15 and 35 ml/m2. In each group the increases in PEV and PBV were proporationate, so that the ratio of PEV/PBV DID NOT CHANGE SIGNIFICANTLY BETWEEN THE CONTROL AND INTERVENTION STATES. Thus PEV and PBV increases occurred with elevations in pulmonary vascular pressures whether or not blood flow increased. Our data in patients with normal pulmonary vascular beds (i.e., coronary artery disease and aortic valve disease) strongly support the hypothesis that recruitment of vascular channels accounts for the acute changes in PEV and PBV and that the changes in PEV over a brief period of time do not necessarily reflect a "true" increase in extravascular lung water. Although pressures are higher in the lungs of patients with mitral valve disease, the data also suggest that recruitment is likely to be the mechanism for the observed proportionate increase in pulmonary extravascular volume and pulmonary blood volume.
对114例接受右心及经房间隔（87例）或逆行（27例）左心导管检查的患者，研究了仰卧位腿部运动或心房起搏的急性血流动力学效应。71例患者——15例患有冠状动脉疾病、22例患有主动脉瓣疾病、34例患有二尖瓣疾病——在自行车测力计上进行运动。43例患者，其中22例患有冠状动脉疾病、9例患有主动脉瓣疾病、12例患有二尖瓣疾病，在快速心房起搏期间接受研究。在对照状态和急性干预期间测量心脏指数（CI）、肺动脉平均压（PAm）和左心房平均压（LAm）、肺血容量（PBV）和肺血管外容量（PEV）。运动和起搏均导致所有患者的PAm平均压（范围37 - 65%）和LAm平均压（范围36 - 43%）显著升高。运动组的心脏指数上升了34%至58%，但起搏患者的心脏指数未改变。在干预期间，除9例接受起搏的主动脉瓣疾病患者外，所有患者的PBV和PEV均显著增加。虽然容量增加了，但未达到5%的显著性水平。对于所有患者，PBV的平均增量在对照基础上为37至123 ml/m²，而PEV上升了15至35 ml/m²。在每组中，PEV和PBV的增加是成比例的，因此在对照状态和干预状态之间，PEV/PBV的比值没有显著变化。因此，无论血流是否增加，随着肺血管压力升高，PEV和PBV都会增加。我们在肺血管床正常的患者（即冠状动脉疾病和主动脉瓣疾病患者）中的数据有力地支持了这一假设，即血管通道的开放是PEV和PBV急性变化的原因，并且短期内PEV的变化不一定反映血管外肺水的“真正”增加。虽然二尖瓣疾病患者肺部的压力较高，但数据也表明，开放可能是观察到的肺血管外容量和肺血容量成比例增加的机制。
