Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, Hamburg-Eppendorf University Hospital, Hamburg, Germany.
J Cardiothorac Vasc Anesth. 2011 Oct;25(5):780-3. doi: 10.1053/j.jvca.2010.09.001. Epub 2010 Nov 5.
Functional preload parameters such as stroke-volume variation (SVV) and pulse-pressure variation (PPV) are superior to filling pressures when assessing volume responsiveness in mechanically ventilated patients. This investigation studied their application in the setting of acute myocardial ischemia and reperfusion (I/R).
Experimental animal study in a university laboratory.
Twenty anesthetized and ventilated pigs.
A temporary reduction of preload was obtained by ventilation with a positive end-expiratory pressure of 10 cmH(2)O. Ischemia was induced by temporary occlusion of the left anterior descending coronary artery for 60 minutes and was followed by 30 minutes of reperfusion.
Animals were instrumented with an ultrasonic aortic flow probe to monitor stroke volume (SV) and SVV. Arterial pressure and PPV were recorded with a microtip catheter; left ventricular volume and pressure were registered by a conductance catheter. Respective hemodynamic measurements were made before, during, and after PEEP; before and after the induction of I/R. Eleven animals survived I/R and were analyzed. Before I/R, SVV (r = 0.87, p < 0.001) and PPV (r = 0.75, p < 0.05) during PEEP correlated significantly with relative changes in SV caused by the release of PEEP. Changes in SVV (r = 0.82, p < 0.01) and PPV (r = 0.67, p < 0.05) correlated significantly with relative changes in SV. After I/R, neither the relations between changes in SV to SVV or PPV during PEEP nor the relations between changes in SVV or PPV to changes in SV reached significance.
SVV and PPV did not reflect volume responsiveness in an experimental model of acute myocardial I/R.
在机械通气患者中评估容量反应性时，功能前负荷参数（如每搏量变异度 [SVV] 和脉压变异度 [PPV]）优于充盈压。本研究探讨了它们在急性心肌缺血再灌注（I/R）中的应用。
大学实验室中的动物实验研究。
20 只麻醉和通气的猪。
通过给予 10 cmH2O 的呼气末正压通气来获得前负荷的暂时降低。通过暂时阻塞左前降支冠状动脉 60 分钟来诱导缺血，然后再进行 30 分钟的再灌注。
动物通过超声主动脉流量探头监测每搏量（SV）和 SVV。通过微导管记录动脉压和 PPV；通过电导导管记录左心室容积和压力。在 PEEP 前后、I/R 前后进行了相应的血流动力学测量。11 只动物存活 I/R 并进行了分析。在 I/R 之前，PEEP 期间的 SVV（r = 0.87，p < 0.001）和 PPV（r = 0.75，p < 0.05）与 PEEP 释放引起的 SV 相对变化显著相关。SVV（r = 0.82，p < 0.01）和 PPV（r = 0.67，p < 0.05）的变化与 SV 的相对变化显著相关。在 I/R 后，SVV 和 PPV 在 PEEP 期间的变化与 SV 的变化之间的关系，以及 SVV 和 PPV 的变化与 SV 的变化之间的关系均不再具有统计学意义。
在急性心肌 I/R 的实验模型中，SVV 和 PPV 不能反映容量反应性。
