Rulf E N, Mitchell M M, Prakash O, Rijsterborg H, Cruz E, Deryck Y L, Rating W, Schepp R M, Siphanto K, Van der Woerd A
Department of Cardiology, Academic Hospital Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
J Cardiothorac Anesth. 1990 Feb;4(1):19-24. doi: 10.1016/0888-6296(90)90441-h.
Radial arterial pressure can significantly underestimate central aortic pressure in the postcardiopulmonary bypass (post-CPB) period. At the study institution, routine monitoring of perioperative arterial pressure in adult patients undergoing cardiac surgery is performed with a long radial artery catheter with the distal end positioned in the subclavian artery. In 68 patients presenting for elective cardiac surgery, both a conventional short radial artery catheter and a contralateral long radial artery catheter were placed. Analysis of radial and subclavian arterial pressures post-CPB in the first 47 patients showed average maximum differences of 7 mm Hg systolic and 4 mm Hg mean. In 15% of patients, the differences were clinically significant (greater than 20 mm Hg systolic and/or greater than 14 mm Hg mean). In 28 patients, central aortic pressure was measured post-CPB, and subclavian artery pressure was found to be an excellent estimator of central aortic pressure. There were no significant complications related to using long radial artery catheters in the 68 patients who were followed prospectively. Monitoring subclavian arterial pressure by percutaneous insertion of a long radial artery catheter provides a reliable estimation of central aortic pressure, even in patients with significant radial artery-to-central aortic pressure gradients post-CPB.
在体外循环（CPB）后阶段，桡动脉压可能会显著低估中心主动脉压。在本研究机构，对于接受心脏手术的成年患者，围手术期动脉压的常规监测是通过将远端置于锁骨下动脉的长桡动脉导管进行的。在68例择期心脏手术患者中，同时放置了一根传统的短桡动脉导管和对侧的长桡动脉导管。对前47例患者CPB后的桡动脉和锁骨下动脉压进行分析，结果显示收缩压平均最大差值为7 mmHg，平均压平均最大差值为4 mmHg。在15%的患者中，这些差值具有临床意义（收缩压大于20 mmHg和/或平均压大于14 mmHg）。在28例患者中，CPB后测量了中心主动脉压，发现锁骨下动脉压是中心主动脉压的良好估计指标。在对68例患者进行前瞻性随访的过程中，使用长桡动脉导管未出现明显并发症。通过经皮插入长桡动脉导管监测锁骨下动脉压，即使在CPB后桡动脉与中心主动脉压存在显著梯度的患者中，也能可靠地估计中心主动脉压。
