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当达到足够的血管充盈时，动脉 dp/dtmax 能准确反映休克时左心室的收缩力。

Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved.

机构信息

Medical Intensive Care Unit, Emergency Department, University Hospital of Liège, and Faculty of Sciences, University of Liège, Liège, Belgium.

出版信息

BMC Cardiovasc Disord. 2012 Mar 1;12:13. doi: 10.1186/1471-2261-12-13.

DOI:10.1186/1471-2261-12-13
PMID:22380679
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3313844/
Abstract

BACKGROUND

Peak first derivative of femoral artery pressure (arterial dP/dtmax) derived from fluid-filled catheter remains questionable to assess left ventricular (LV) contractility during shock. The aim of this study was to test if arterial dP/dtmax is reliable for assessing LV contractility during various hemodynamic conditions such as endotoxin-induced shock and catecholamine infusion.

METHODS

Ventricular pressure-volume data obtained with a conductance catheter and invasive arterial pressure obtained with a fluid-filled catheter were continuously recorded in 6 anaesthetized and mechanically ventilated pigs. After a stabilization period, endotoxin was infused to induce shock. Catecholamines were transiently administrated during shock. Arterial dP/dtmax was compared to end-systolic elastance (Ees), the gold standard method for assessing LV contractility.

RESULTS

Endotoxin-induced shock and catecholamine infusion lead to significant variations in LV contractility. Overall, significant correlation (r=0.51; p<0.001) but low agreement between the two methods were observed. However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV)≤11% (r=0.77; p<0.001).

CONCLUSION

While arterial dP/dtmax and Ees were significantly correlated during various hemodynamic conditions, arterial dP/dtmax was more accurate for assessing LV contractility when adequate vascular filling, defined as PPV≤11%, was achieved.

摘要

背景

从充满液体的导管获得的股动脉压力的峰值一阶导数（动脉 dp/dtmax）用于评估休克期间的左心室（LV）收缩性仍存在疑问。本研究的目的是测试在各种血流动力学条件下，如内毒素诱导的休克和儿茶酚胺输注期间，动脉 dp/dtmax 是否可靠地用于评估 LV 收缩性。

方法

在 6 只麻醉和机械通气的猪中，连续记录使用传导导管获得的心室压力-容积数据和使用充满液体的导管获得的有创动脉压。在稳定期后，输注内毒素以诱导休克。在休克期间短暂给予儿茶酚胺。将动脉 dp/dtmax 与评估 LV 收缩性的金标准方法——收缩末期弹性（Ees）进行比较。

结果

内毒素诱导的休克和儿茶酚胺输注导致 LV 收缩性发生显著变化。总体而言，两种方法之间观察到显著的相关性（r=0.51；p<0.001），但一致性较低。然而，当正压通气引起动脉脉搏压变化（PPV）≤11%时，观察到更好的相关性和更好的一致性（r=0.77；p<0.001）。

结论

虽然在各种血流动力学条件下，动脉 dp/dtmax 和 Ees 之间存在显著相关性，但当达到足够的血管充盈（定义为 PPV≤11%）时，动脉 dp/dtmax 更准确地评估 LV 收缩性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/ea8781e2661f/1471-2261-12-13-5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/fcdbe9c66557/1471-2261-12-13-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/4a25f3216b83/1471-2261-12-13-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/7e7a6d46baf3/1471-2261-12-13-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/1d2e4e072bde/1471-2261-12-13-4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/ea8781e2661f/1471-2261-12-13-5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/fcdbe9c66557/1471-2261-12-13-1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/4a25f3216b83/1471-2261-12-13-2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/7e7a6d46baf3/1471-2261-12-13-3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/1d2e4e072bde/1471-2261-12-13-4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2c38/3313844/ea8781e2661f/1471-2261-12-13-5.jpg

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