Boldt Joachim, Zickmann Bernfried, Herold Christoph, Dapper Friedhelm, Hempelmann Gunter
Department of Anesthesiology and Intensive Care Medicine and the Department of Cardiovascular Surgery, Justus-Liebig-University Giessen, Giessen, Germany.
J Cardiothorac Vasc Anesth. 1992 Feb;6(1):24-28. doi: 10.1016/1053-0770(91)90040-Z.
Complex interrelationships exist between the right (RV) and the left ventricles (LV). Therefore, in 30 consecutive patients with reduced LV function (left ventricular ejection fraction [LVEF]) less than 40% undergoing myocardial revascularization, RV hemodynamics were studied from the beginning of anesthesia until the end of the operation. The data were compared with 30 consecutive patients with normal LVEF (greater than 70%). Ventricular function was assessed during left heart catheterization, which was carried out within 1 month of the operation. In addition to standard hemodynamic variables, RV ejection fraction (RVEF), RV end-diastolic volume (RVEDV), and RV end-systolic volume (RVESV) were monitored by the thermodilution technique. The two groups did not differ preoperatively with regard to RVEF, pressure (MAP, PAP, PCWP, RAP, RVPsyst, RVEDP), cardiac index (CI), and volume variables (RVESV, RVEDV). However, when the group with preoperatively reduced LVEF was subdivided into patients with severely reduced LVEF (less than 30%; n = 14; mean value 25.1%) and patients with moderately reduced LVEF (30%-40%; n = 16; mean value 37.3%), RVEF was significantly lower in the patients with a LVEF below 30% throughout the entire investigation period. RVEDV and RVESV were significantly higher in these patients. In conjunction with the lower RVEF and normal PAP, this suggests reduced RV function. It can be concluded that a severely reduced preoperative LVEF (less than 30%) may also be associated with impaired RV function.
右心室(RV)和左心室(LV)之间存在复杂的相互关系。因此,对30例连续接受心肌血运重建术且左心室功能降低(左心室射血分数[LVEF])低于40%的患者,从麻醉开始到手术结束对右心室血流动力学进行了研究。将这些数据与30例连续LVEF正常(大于70%)的患者进行比较。在术后1个月内进行左心导管检查时评估心室功能。除了标准血流动力学变量外,还通过热稀释技术监测右心室射血分数(RVEF)、右心室舒张末期容积(RVEDV)和右心室收缩末期容积(RVESV)。两组患者术前在RVEF、压力(平均动脉压、肺动脉压、肺毛细血管楔压、右心房压、右心室收缩压、右心室舒张末期压)、心脏指数(CI)和容积变量(RVESV、RVEDV)方面无差异。然而,当术前LVEF降低的组再细分为LVEF严重降低(低于30%;n = 14;平均值25.1%)和LVEF中度降低(30%-40%;n = 16;平均值37.3%)的患者时,在整个研究期间,LVEF低于30%的患者RVEF显著更低。这些患者的RVEDV和RVESV显著更高。结合较低的RVEF和正常的肺动脉压,这提示右心室功能降低。可以得出结论,术前严重降低的LVEF(低于30%)也可能与右心室功能受损有关。