Poelaert J I, Reichert C L, Koolen J J, Everaert J A, Visser C A
Department of Intensive Care, University Hospital Ghent, Belgium.
J Cardiothorac Vasc Anesth. 1992 Aug;6(4):438-43. doi: 10.1016/1053-0770(92)90010-5.
Transesophageal echocardiography was used to extend knowledge about the impact of positive end-expiratory pressure (PEEP) during mechanical ventilation on right and left ventricular function and right ventricular impedance. At 20 cmH2O PEEP, a progressive increase of right ventricular end-diastolic area was seen (27%) that coincided with a reduction of early left ventricular filling velocity (25%) across the mitral valve, and a decrease of both pulmonary artery flow velocity (end-expiration 27% and end-inspiration 42%) and time-velocity index (end-inspiration 25%). As these changes were not accompanied by a change of the fractional area of contraction, the increase of the right ventricular diameter might be explained by right ventricular compensation due to an imbalance between augmented right ventricular impedance and reduced venous return.
经食管超声心动图被用于拓展关于机械通气过程中呼气末正压（PEEP）对左右心室功能及右心室阻抗影响的认识。在20 cmH₂O的PEEP水平下，观察到右心室舒张末期面积逐渐增加（27%），这与二尖瓣处左心室早期充盈速度降低（25%）、肺动脉血流速度（呼气末降低27%，吸气末降低42%）和时间-速度指数（吸气末降低25%）的下降同时出现。由于这些变化并未伴随收缩分数面积的改变，右心室直径的增加可能是由于右心室阻抗增加与静脉回流减少之间的失衡导致右心室代偿所致。
