心脏手术后右心室舒张末期容积监测

Right ventricular end-diastolic volume monitoring after cardiac surgery.

作者信息

Ishida Toru, Lee Takeshi, Shimabukuro Takashi, Niinami Hiroshi

机构信息

Department of Cardiovascular Surgery, Saitama Tobu Junkanki Hospital, Saitama, Japan.

出版信息

Ann Thorac Cardiovasc Surg. 2004 Jun;10(3):167-70.

PMID:15312012

Abstract

INTRODUCTION

In the postoperative management of cardiac surgery patients, pulmonary capillary wedge pressure (PCWP) and central venous pressure (CVP) are the most commonly used parameters of preload. However, these pressure parameters are easily affected by ventricular compliance, positive end-expiratory pressure and other factors. The aim of this study was to evaluate whether right ventricular end-diastolic volume index (RVEDVI) reflects cardiac output or ventricular preload in patients after cardiac surgery during postoperative management.

METHODS

We performed measurements in 31 patients postoperatively in the intensive care unit every 1 or 2 hours using a modified thermodilution catheter.

RESULTS

There were 999 measured hemodynamic data sets and the measurement duration was 47 +/- 21 hours (mean +/- SD). RVEDVI was 119 +/- 32 ml/m(2), cardiac index (CI) was 2.7 +/- 0.7 L/min/m(2), and PCWP was 11 +/- 4 mmHg. A significant correlation was found between RVEDVI, CVP and CI in 15 of 31 patients, and between PCWP and CI in 4 of 22 patients. In 33% of cases, CVP showed a negative correlation with CI, whereas 7% showed a negative correlation between RVEDVI and CI.

CONCLUSION

RVEDVI was a significant index during the postoperative management after cardiac surgery.

摘要

引言

在心脏手术患者的术后管理中，肺毛细血管楔压（PCWP）和中心静脉压（CVP）是最常用的前负荷参数。然而，这些压力参数很容易受到心室顺应性、呼气末正压及其他因素的影响。本研究的目的是评估右心室舒张末期容积指数（RVEDVI）在心脏手术后患者的术后管理期间是否能反映心输出量或心室前负荷。

方法

我们在重症监护病房对31例患者术后每隔1或2小时使用改良热稀释导管进行测量。

结果

共获得999组血流动力学测量数据集，测量持续时间为47±21小时（平均值±标准差）。RVEDVI为119±32ml/m²，心脏指数（CI）为2.7±0.7L/min/m²，PCWP为11±4mmHg。31例患者中有15例RVEDVI、CVP与CI之间存在显著相关性，22例患者中有4例PCWP与CI之间存在显著相关性。在33%的病例中，CVP与CI呈负相关，而7%的病例中RVEDVI与CI呈负相关。