Manecke Gerard R, Parimucha Michael, Stratmann Greg, Wilson William C, Roth David M, Auger William R, Kerr Kim M, Jamieson Stuart W, Kapelanski David P, Mitchell Mark M
Department of Anesthesiology, UCSD Medical Center, San Diego, CA 92103,
J Cardiothorac Vasc Anesth. 2004 Apr;18(2):175-9. doi: 10.1053/j.jvca.2004.01.023.
To determine the femoral-to-radial arterial pressure gradient, as well as the factors associated with them, in patients receiving cardiopulmonary bypass (CPB) with profound hypothermia and circulatory arrest.
Retrospective automated hemodynamic record review.
University hospital.
Patients undergoing pulmonary thromboendarterectomy with deep hypothermic circulatory arrest.
The automated hemodynamic records of 54 consecutive patients undergoing pulmonary thromboendarterectomy with deep hypothermic circulatory arrest were reviewed, comparing the femoral and radial arterial pressures throughout the intraoperative period. In 20 of the patients, the hemodynamic data from the first 16 postoperative hours were also studied. Forty-one of 54 (76%) of the patients exhibited a mean arterial gradient of at least 10 mmHg either during or after CPB, femoral being higher. Clinically significant gradients were noted throughout the CPB period and the post-CPB period in these patients. In the 54 patients studied, the systolic blood pressure (SBP) gradient was 32 +/- 19 mmHg after CPB (95% confidence limits 28.2 mmHg, 39.0 mmHg), and the mean arterial pressure (MAP) gradient was 6.3 +/- 4.9 mmHg (95% confidence limits 5.5 mmHg, 8.6 mmHg). The duration of clinically significant SBP (>10 mmHg) and MAP (>5 mmHg) gradients in the postoperative period were 5.2 +/- 5.7 hours and 5.8 +/- 7.2 hours, respectively. Advanced age correlated with high post-CPB pressure gradients in this population and was associated with prolonged postoperative resolution of the gradients.
The femoral-to-radial arterial pressure gradients, particularly systolic, after CPB, were greater and of longer duration in these patients undergoing deep hypothermic circulatory arrest than gradients previously reported for routine CPB. Central arterial pressure monitoring is recommended for patients undergoing deep hypothermic circulatory arrest, being valuable both for intraoperative and postoperative care.
确定在接受体外循环（CPB）并伴有深度低温和循环停止的患者中，股动脉与桡动脉之间的压力梯度以及与之相关的因素。
回顾性自动血流动力学记录审查。
大学医院。
接受深低温循环停止下肺动脉血栓内膜剥脱术的患者。
回顾了54例连续接受深低温循环停止下肺动脉血栓内膜剥脱术患者的自动血流动力学记录，比较了术中整个时间段的股动脉和桡动脉压力。在20例患者中，还研究了术后最初16小时的血流动力学数据。54例患者中有41例（76%）在CPB期间或之后表现出平均动脉梯度至少为10 mmHg，股动脉压力更高。在这些患者的整个CPB期间和CPB后期间均观察到具有临床意义的梯度。在所研究的54例患者中，CPB后收缩压（SBP）梯度为32±19 mmHg（95%置信区间28.2 mmHg，39.0 mmHg），平均动脉压（MAP）梯度为6.3±4.9 mmHg（95%置信区间5.5 mmHg，8.6 mmHg）。术后具有临床意义的SBP（>10 mmHg）和MAP（>5 mmHg）梯度持续时间分别为5.2±5.7小时和5.8±7.2小时。在该人群中，高龄与CPB后高压力梯度相关，并且与梯度的术后消退时间延长有关。
在这些接受深低温循环停止的患者中，CPB后股动脉与桡动脉之间的压力梯度，尤其是收缩压梯度，比先前报道的常规CPB梯度更大且持续时间更长。建议对接受深低温循环停止的患者进行中心动脉压监测，这对术中及术后护理均有价值。
