Department of Anesthesiology, the First Affiliated Hospital with Nanjing Medical University/Jiangsu Province Hospital, Nanjing, China.
PLoS One. 2013 Jul 22;8(7):e68890. doi: 10.1371/journal.pone.0068890. Print 2013.
To investigate the risk factors involved in radial-femoral artery pressure gradient after cardiac surgery.
In this retrospective study, we reviewed 412 cardiac surgeries with both femoral artery pressure and radial artery pressure monitoring before cardiopulmonary bypass. 138 patients had radial-femoral artery pressure gradient after cardiopulmonary bypass (group P) but 263 were not (group N). Their hemodynamic data and other demographic data were analyzed.
Phenylephrine usage was 1.7±1.1 mg in group N and 2.9±1.2 mg in group P (P<0.001). Total adrenaline usage was 229.2±116.9 µg in group N and 400.6±145.1 µg in group P (P<0.001). SBP gradient was -4±3, 14±9, 10±4, 0±11 mmHg in group P and -3±3, 0±1, -1±9, -6±4 mmHg in group N after induction, during discontinuation of CPB, at the end of surgery and 1 postoperative day respectively. DBP gradient was 3±3, -1±9, 4±5, 0±8 mmHg in group P and 3±3, 5±2, 7±5, 0±8 mmHg in group N after induction, during discontinuation of CPB, at the end of surgery and 1 postoperative day respectively. MAP gradient was 1±2, 4±6, 6±4, 0±8 mmHg in group P and 1±2, 3±1, 1±4, -2±5 mmHg in group N after induction, during discontinuation of CPB, at the end of surgery and 1 postoperative day respectively. Significant arterial pressure gradient emerged during discontinuation of CPB and at the end of surgery, which was more obvious in group P(P<0.01). CI was 2.0±0.3, 2.3±0.4,2.3±0.4, 2.2±0.4 L/min/m(2) in group P and 2.1±0.3, 2.8±0.5,2.8±0.5, 2.8±0.5 L/min/m(2) in group N at baseline, after discontinuation of CPB, at the end of surgery and the first postoperative day (P<0.001).
Detecting the exact central artery pressure is most important when patients have artery pressure gradients after cardiac surgery. Use inotropic agents to improve cardiac output, avoiding excessive vasoconstriction might reduce artery pressure gradient.
探讨心脏手术后桡动脉-股动脉压力梯度升高的危险因素。
本回顾性研究纳入了 412 例行体外循环（CPB）心脏手术的患者，所有患者在 CPB 前均进行了股动脉和桡动脉压力监测。其中 138 例患者在 CPB 后出现桡动脉-股动脉压力梯度升高（P 组），而其余 263 例患者未出现（N 组）。分析比较两组患者的血流动力学数据和其他人口统计学资料。
N 组患者使用去氧肾上腺素的剂量为 1.7±1.1mg，P 组为 2.9±1.2mg（P<0.001）。N 组患者使用肾上腺素的总量为 229.2±116.9μg，P 组为 400.6±145.1μg（P<0.001）。诱导后、CPB 停止时、手术结束时和术后第 1 天，P 组患者的 SBP 梯度分别为-4±3mmHg、14±9mmHg、10±4mmHg、0±11mmHg，N 组分别为-3±3mmHg、0±1mmHg、-1±9mmHg、-6±4mmHg。诱导后、CPB 停止时、手术结束时和术后第 1 天，P 组患者的 DBP 梯度分别为 3±3mmHg、-1±9mmHg、4±5mmHg、0±8mmHg，N 组分别为 3±3mmHg、5±2mmHg、7±5mmHg、0±8mmHg。诱导后、CPB 停止时、手术结束时和术后第 1 天，P 组患者的 MAP 梯度分别为 1±2mmHg、4±6mmHg、6±4mmHg、0±8mmHg，N 组分别为 1±2mmHg、3±1mmHg、1±4mmHg、-2±5mmHg。CPB 停止时和手术结束时两组患者均出现明显的动脉压力梯度，P 组更明显（P<0.01）。CPB 停止时、手术结束时和术后第 1 天，P 组患者的 CI 分别为 2.0±0.3L/min/m(2)、2.3±0.4L/min/m(2)、2.3±0.4L/min/m(2)，N 组分别为 2.1±0.3L/min/m(2)、2.8±0.5L/min/m(2)、2.8±0.5L/min/m(2)，差异均有统计学意义（P<0.001）。
心脏手术后出现动脉压力梯度时，明确中心动脉压力最重要。使用正性肌力药物改善心输出量，避免过度血管收缩可能会降低动脉压力梯度。
