Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
J Anesth. 2013 Aug;27(4):512-20. doi: 10.1007/s00540-013-1558-z. Epub 2013 Mar 2.
Appropriate adjustment of cardiac preload is essential to maintain cardiac output (CO), especially in patients after cardiac surgery. This study was intended to determine whether index of right ventricular end-diastolic volume (RVEDVI), corrected RVEDVI using ejection fraction (cRVEDVI), index of initial distribution volume of glucose (IDVGI), or cardiac filling pressures are correlated with cardiac index (CI) following cardiac surgery in the presence or absence of arrhythmias.
Eighty-six consecutive cardiac surgical patients were studied. Patients were divided into two groups: the non-arrhythmia (NA) group (n = 72) and the arrhythmia (A) group (n = 14). Three sets of measurements were performed: on admission to the ICU and daily on the first 2 postoperative days. The relationship between each cardiac preload variable and cardiac index (CI) was evaluated. A p value less than 0.05 indicated statistically significant differences.
Each studied variable was not different between the two groups immediately after admission to the ICU. cRVEDVI had a linear correlation with CI in both group (NA group: r = 0.67, n = 216, p < 0.001; A group: r = 0.77, n = 42, p < 0.001), but RVEDVI had a poor correlation with CI (NA group: r = 0.27, n = 216, p < 0.001; A group: r = 0.19, n = 42, p = 0.036). IDVGI had a linear correlation with CI (NA group: r = 0.49, n = 216, p < 0.001; A group: r = 0.61, n = 42, p < 0.001), Cardiac filling pressures had no correlation with CI.
Our results demonstrated that cRVEDVI and IDVGI were correlated with CI in the presence or absence of arrhythmias. cRVEDVI and IDVGI have potential as indirect cardiac preload markers following cardiac surgery.
适当调整心脏前负荷对于维持心输出量(CO)至关重要,尤其是在心脏手术后的患者中。本研究旨在确定右心室舒张末期容积指数(RVEDVI)、射血分数校正的 RVEDVI(cRVEDVI)、初始分布容积指数(IDVGI)或心脏充盈压是否与心律失常存在或不存在时心脏手术后的心指数(CI)相关。
研究了 86 例连续接受心脏手术的患者。患者分为两组:无心律失常(NA)组(n = 72)和心律失常(A)组(n = 14)。在 ICU 入院时和术后第 1 至 2 天每天进行三组测量。评估了每个心脏前负荷变量与心指数(CI)的关系。p 值小于 0.05 表示具有统计学意义的差异。
两组患者在入院时,每个研究变量均无差异。cRVEDVI 在两组中均与 CI 呈线性相关(NA 组:r = 0.67,n = 216,p <0.001;A 组:r = 0.77,n = 42,p <0.001),但 RVEDVI 与 CI 的相关性较差(NA 组:r = 0.27,n = 216,p <0.001;A 组:r = 0.19,n = 42,p = 0.036)。IDVGI 与 CI 呈线性相关(NA 组:r = 0.49,n = 216,p <0.001;A 组:r = 0.61,n = 42,p <0.001),心脏充盈压与 CI 无相关性。
我们的结果表明,cRVEDVI 和 IDVGI 在存在或不存在心律失常的情况下与 CI 相关。cRVEDVI 和 IDVGI 在心外科手术后具有作为间接心脏前负荷标志物的潜力。