Maillé J G
Ann Anesthesiol Fr. 1976;17(12):1362-8.
The author studies only the usual investigations required for watching E.C.C. during the operatory period and directly afterwards. During E.C.C., one must essentially oversee the flow (2,4l/m2 or 70 ml/kg), the arterial pressure (70 torrs) essential factor for myocardiac injection, the C.V.P., where excess is factor of cerebral oedema, the peripheric vascular resistances (P.V.R.) which inform on the level of vasomotoricity. Control of pulmonary capillary pressure (P.C.P.), which is under E.C.C. the reflection of the left ventricular pressure (L.V.P.) is also a capital element of this watching (any elevation of L.V.P. is factor of sub-endocardiac ischemia and of acute pulmonary edema). In post E.C.C., the same parameters will be watched. A cardiac output equal or inferior to 2 l/m2 involve an immediate treatment. The C.V.P. allows adaptation of blood quantity. Calcul of V.P.R. sets treatment of low cardiac output. C.P.C. control allows evaluation of left ventricular efficacity. These datas must be completed by calcul of subendocardiac viability by studying the arterial pressure curves which inform on oxygen supply and demand, and by the contractility index measure (aortic output speed and measure of systolic interval).
作者仅研究了在手术期间及术后直接观察体外循环(E.C.C.)所需的常规检查项目。在体外循环期间,必须主要监测流量(2.4升/平方米或70毫升/千克)、动脉压(70托),这是心肌灌注的关键因素、中心静脉压(C.V.P.),过高是脑水肿的因素、外周血管阻力(P.V.R.),它反映血管运动功能水平。控制肺毛细血管压(P.C.P.),在体外循环下它反映左心室压力(L.V.P.),这也是该监测的关键要素(任何左心室压力升高都是心内膜下缺血和急性肺水肿的因素)。在体外循环后,将监测相同的参数。心输出量等于或低于2升/平方米需要立即治疗。中心静脉压可用于调整血容量。外周血管阻力的计算用于设定低心输出量的治疗方案。肺毛细血管压的控制可评估左心室功能。这些数据必须通过研究反映氧供需的动脉压曲线来计算心内膜下活力,并通过测量收缩期指数(主动脉输出速度和收缩期间隔测量)来补充。