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热应激和冷应激对人体直立位时中心血管压力关系的影响。

Effects of heat and cold stress on central vascular pressure relationships during orthostasis in humans.

作者信息

Wilson T E, Tollund C, Yoshiga C C, Dawson E A, Nissen P, Secher N H, Crandall C G

机构信息

Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, USA.

出版信息

J Physiol. 2007 Nov 15;585(Pt 1):279-85. doi: 10.1113/jphysiol.2007.137901. Epub 2007 Sep 27.

Abstract

Central venous pressure (CVP) provides information regarding right ventricular filling pressure, but is often assumed to reflect left ventricular filling pressure. It remains unknown whether this assumption is correct during thermal challenges when CVP is elevated during skin-surface cooling or reduced during whole-body heating. The primary objective of this study was to test the hypothesis that changes in CVP reflect those in left ventricular filling pressure, as expressed by pulmonary capillary wedge pressure (PCWP), during lower-body negative pressure (LBNP) while subjects are normothermic, during skin-surface cooling, and during whole-body heating. In 11 subjects, skin-surface cooling was imposed by perfusing 16 degrees C water through a water-perfused suit worn by each subject, while heat stress was imposed by perfusing 47 degrees C water through the suit sufficient to increase internal temperature 0.95 +/- 0.07 degrees C (mean +/- s.e.m.). While normothermic, CVP was 6.3 +/- 0.2 mmHg and PCWP was 9.5 +/- 0.3 mmHg. These pressures increased during skin-surface cooling (7.8 +/- 0.2 and 11.1 +/- 0.3 mmHg, respectively; P < 0.05) and decreased during whole-body heating (3.6 +/- 0.1 and 6.5 +/- 0.2 mmHg, respectively; P < 0.05). The decrease in CVP with LBNP was correlated with the reduction in PCWP during normothermia (r = 0.93), skin-surface cooling (r = 0.91), and whole-body heating (r = 0.81; all P < 0.001). When these three thermal conditions were combined, the overall r value between CVP and PCWP was 0.92. These data suggest that in the assessed thermal conditions, CVP appropriately tracks left ventricular filling pressure as indexed by PCWP. The correlation between these values provides confidence for the use of CVP in studies assessing ventricular preload during thermal and combined thermal and orthostatic perturbations.

摘要

中心静脉压(CVP)可提供有关右心室充盈压的信息,但人们常常认为它能反映左心室充盈压。在热刺激期间,当体表冷却时CVP升高或全身加热时CVP降低时,这种假设是否正确仍不清楚。本研究的主要目的是检验以下假设:在受试者体温正常、体表冷却和全身加热期间,下体负压(LBNP)时CVP的变化反映了肺毛细血管楔压(PCWP)所表示的左心室充盈压的变化。在11名受试者中,通过给每位受试者穿着的水灌注服灌注16℃的水来进行体表冷却,而通过给该套装灌注47℃的水来施加热应激,足以使体温升高0.95±0.07℃(平均值±标准误)。体温正常时,CVP为6.3±0.2 mmHg,PCWP为9.5±0.3 mmHg。这些压力在体表冷却期间升高(分别为7.8±0.2和11.1±0.3 mmHg;P<0.05),在全身加热期间降低(分别为3.6±0.1和6.5±0.2 mmHg;P<0.05)。LBNP时CVP的降低与体温正常时(r = 0.93)、体表冷却时(r = 0.91)和全身加热时(r = 0.81;所有P<0.001)PCWP的降低相关。当将这三种热状态合并时,CVP与PCWP之间的总体r值为0.92。这些数据表明,在评估的热状态下,CVP能恰当地追踪以PCWP为指标的左心室充盈压。这些值之间的相关性为在评估热及热与体位改变联合作用期间心室前负荷的研究中使用CVP提供了信心。

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