Intensive Care Directorate, St George's Healthcare NHS Trust and Medical School, Tooting, London, SW17 0QT, UK.
Intensive Care Med. 2013 Jul;39(7):1299-305. doi: 10.1007/s00134-013-2928-6. Epub 2013 May 8.
The difference between mean systemic filling (Pmsf) and central venous pressure (CVP) is the venous return gradient (dVR). The aim of this study is to assess the significance of the Pmsf analogue (Pmsa) and the dVR during a fluid challenge.
We performed a prospective observational study in postsurgical patients. Patients were monitored with a central venous catheter, a LiDCO™plus and the Navigator™. A 250-ml intravenous fluid challenge was given over 5 min. A positive response to the fluid challenge was defined as either a stroke volume (SV) or cardiac output increase of greater than 10 %.
A total of 101 fluid challenges were observed in 39 patients. In 43 events (42.6 %) the SV and CO increased by more than 10 %. Pmsa increased similarly during a fluid challenge in responders and non-responders (3.1 ± 1.9 vs. 3.1 ± 1.8, p = 0.9), whereas the dVR increased in responders (1.16 ± 0.8 vs. 0.2 ± 1, p < 0.001) as among non-responders CVP increased along with Pmsa (2.9 ± 1.7 vs. 3.1 ± 1.8, p = 0.15). Resistance to venous return did not change immediately after a fluid challenge. Heart performance (Eh) decreased significantly among non-responders (0.41 ± 0.15 vs. 0.34 ± 0.13, p < 0.001) whereas among responders it did not change when compared with baseline value (0.35 ± 0.15 vs. 0.34 ± 0.12, p = 0.15).
The changes in Pmsa and dVR measured at the bedside during a fluid challenge are consistent with the cardiovascular model described by Guyton.
平均系统充盈压（Pmsf）与中心静脉压（CVP）的差值为静脉回流梯度（dVR）。本研究旨在评估在液体冲击期间 Pmsf 类似物（Pmsa）和 dVR 的意义。
我们对术后患者进行了前瞻性观察性研究。患者通过中心静脉导管、LiDCO™plus 和 Navigator™进行监测。在 5 分钟内给予 250ml 静脉输液冲击。将液体冲击后 SV 或心输出量增加大于 10%定义为阳性反应。
共观察到 39 例患者的 101 次液体冲击。在 43 次事件（42.6%）中，SV 和 CO 增加大于 10%。在有反应者和无反应者中，液体冲击期间 Pmsa 增加相似（3.1±1.9 vs. 3.1±1.8，p=0.9），而 dVR 在有反应者中增加（1.16±0.8 vs. 0.2±1，p<0.001），而在无反应者中 CVP 随 Pmsa 增加（2.9±1.7 vs. 3.1±1.8，p=0.15）。静脉回流阻力在液体冲击后立即没有变化。在无反应者中，心脏性能（Eh）显著降低（0.41±0.15 vs. 0.34±0.13，p<0.001），而在有反应者中与基线值相比没有变化（0.35±0.15 vs. 0.34±0.12，p=0.15）。
在液体冲击期间床边测量的 Pmsa 和 dVR 的变化与 Guyton 描述的心血管模型一致。
