Siniscalchi A, Pavesi M, Piraccini E, De Pietri L, Braglia V, Di Benedetto F, Lauro A, Spedicato S, Dante A, Pinna A D, Faenza S
Division of Anesthesiology, University of Bologna, Bologna, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2541-3. doi: 10.1016/j.transproceed.2005.06.100.
The objective of this study was to compare the accuracy of 2 variables: pulmonary artery occlusion pressure (PAOP) and right ventricular end diastolic volume index (RVEDVI) as predictors of the hemodynamic response to fluid challenge as well as definition of the overall correlation between RVEDVI and change in PAOP, right ventricular ejection fraction (RVEF), central venous pressure (CVP), and determination of the right ventricular function during orthotopic liver transplantation.
A modified pulmonary artery catheter equipped with a fast response thermistor was used to determine RVEF, allowing calculation of RVEF end-diastolic volume index (EDVI, as the ratio of stroke index [SI] to EF). The above-mentioned hemodynamic measures were taken in 4 phases: T0, after induction of anesthesia; T1, during anhepatic phase; T2, 30' after graft reperfusion; and T3, at the end of surgery.
The variation of the REF value was 36 +/- 4% and 39 +/- 6%. Linear regression analysis showed a significant correlation between RVEDVI (range, 133 +/- 33-145 +/- 40 mL/m(2)) and stroke volume index (SVI) in each phase (r(2) = 0.49, P < .01; r(2) = 0.57, P < .01) at T0 and T1, respectively, and at T2 and T3 (r(2) = 0.51, P < .01; r(2) = 0.44, P < .01), respectively. No significant variations in the linear regression analysis between RVEDVI, PAOP, CVP, and RVEF were observed. No relationship was found between PAOP (range, 10 +/- 2-6 +/- 2 mm Hg) and SVI.
RVEDVI may be the best clinical estimate of right ventricular preload. In fact, minor changes of RVEF have been recorded, confirming that RV function was not altered during uncomplicated orthotopic liver transplantation.
本研究的目的是比较两个变量的准确性：肺动脉闭塞压（PAOP）和右心室舒张末期容积指数（RVEDVI）作为液体冲击血流动力学反应预测指标的准确性，以及确定RVEDVI与PAOP变化、右心室射血分数（RVEF）、中心静脉压（CVP）之间的总体相关性，并在原位肝移植期间确定右心室功能。
使用配备快速响应热敏电阻的改良肺动脉导管来测定RVEF，从而计算出RVEF舒张末期容积指数（EDVI，作为每搏量指数[SI]与EF的比值）。上述血流动力学测量在4个阶段进行：T0，麻醉诱导后；T1，无肝期；T2，移植肝再灌注后30分钟；T3，手术结束时。
RVEF值的变化分别为36±4%和39±6%。线性回归分析显示，在T0和T1阶段，以及T2和T3阶段，RVEDVI（范围为133±33 - 145±40 mL/m²）与每搏量指数（SVI）之间均存在显著相关性（r²分别为0.49，P <.01；r²为0.57，P <.01；r²分别为0.51，P <.01；r²为0.44，P <.01）。在RVEDVI、PAOP、CVP和RVEF之间的线性回归分析中未观察到显著变化。未发现PAOP（范围为10±2 - 6±2 mmHg）与SVI之间存在关系。
RVEDVI可能是右心室前负荷的最佳临床评估指标。事实上，已记录到RVEF的微小变化，证实了在无并发症的原位肝移植期间右心室功能未改变。
