Schulman D S, Biondi J W, Zohgbi S, Cecchetti A, Zaret B L, Soufer R
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Am Rev Respir Dis. 1992 Mar;145(3):515-21. doi: 10.1164/ajrccm/145.3.515.
The individual and additive effects of positive end-expiratory pressure (PEEP) and right coronary artery (RCA) occlusion on left ventricular end-diastolic pressure-volume relations (LVEDPVR) were examined in six anesthetized dogs. Right ventricular (RV) and left ventricular (LV) ejection fractions (EF), end-diastolic volume (EDV) and end-systolic volumes (ESV) were measured by thermodilution as PEEP was added before and after RCA occlusion. PEEP alone caused a decline in cardiac output, transmural left atrial pressure (LAP) (6.0 +/- 0.6 to 3.2 +/- 1.4 mm Hg, p less than 0.05), and LVEDV (49 +/- 3 to 36 +/- 4 ml, p less than 0.05). RVEDV, the mean slope (+/- SD) of the LVEDPVR (0.37 +/- 0.16 to 0.30 +/- 0.19) and LAP at a common LV volume (35 ml, V35) did not change with PEEP. RCA occlusion caused cardiac output and RVEF (38 +/- 5 to 27 +/- 5%, p less than 0.05) to decline and RVESV (25 +/- 4 to 33 +/- 6 ml, p less than 0.05) to increase. RVEDV, the slope of the LVEDPVR, and LAP at V35 were unchanged from baseline. The addition of PEEP after RCA occlusion caused cardiac output to decline further. However, unlike before occlusion, there was no change in LAP (6.5 +/- 1.3 to 5.0 +/- 1.4 mm Hg) despite a decline in LVEDV (47 +/- 3 to 29 +/- 6 ml, p less than 0.05). RVESV and RVEDV increased with PEEP after RCA occlusion as did LAP at V35. The slope of the mean LVEDPVR tended to increase (0.98 +/- 1.03).(ABSTRACT TRUNCATED AT 250 WORDS)
在六只麻醉犬中研究了呼气末正压（PEEP）和右冠状动脉（RCA）闭塞对左心室舒张末期压力-容积关系（LVEDPVR）的个体和叠加效应。在RCA闭塞前后添加PEEP时，通过热稀释法测量右心室（RV）和左心室（LV）的射血分数（EF）、舒张末期容积（EDV）和收缩末期容积（ESV）。单独使用PEEP导致心输出量、跨壁左心房压力（LAP）（从6.0±0.6降至3.2±1.4 mmHg，p<0.05）和LVEDV（从49±3降至36±4 ml，p<0.05）下降。RVEDV、LVEDPVR的平均斜率（±标准差）（从0.37±0.16降至0.30±0.19）以及在共同LV容积（35 ml，V35）时的LAP并未随PEEP而改变。RCA闭塞导致心输出量和RVEF（从38±5降至27±5%，p<0.05）下降，RVESV（从25±4增至33±6 ml，p<0.05）增加。RVEDV、LVEDPVR的斜率以及V35时的LAP与基线相比无变化。RCA闭塞后添加PEEP导致心输出量进一步下降。然而，与闭塞前不同，尽管LVEDV下降（从47±3降至29±6 ml，p<0.05），LAP却没有变化（从6.5±1.3降至5.0±1.4 mmHg）。RCA闭塞后，RVESV和RVEDV随PEEP增加，V35时的LAP也增加。平均LVEDPVR的斜率趋于增加（0.98±1.03）。（摘要截于250字）
