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脉搏压变异不能反映脂多糖诱导肺炎机械通气大鼠的每搏量变异。

Pulse pressure variation does not reflect stroke volume variation in mechanically ventilated rats with lipopolysaccharide-induced pneumonia.

机构信息

Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands.

出版信息

Clin Exp Pharmacol Physiol. 2014 Jan;41(1):98-104. doi: 10.1111/1440-1681.12187.

Abstract
  1. The present study examined the relationship between centrally measured stroke volume variation (SVV) and peripherally derived pulse pressure variation (PPV) in the setting of increased total arterial compliance (CA rt ). 2. Ten male Wistar rats were anaesthetized, paralysed and mechanically ventilated before being randomized to receive intrapulmonary lipopolysaccharide (LPS) or no LPS. Pulse pressure (PP) was derived from the left carotid artery, whereas stroke volume (SV) was measured directly in the left ventricle. Values of SVV and PPV were calculated over three breaths. Balloon inflation of a catheter positioned in the inferior vena cava was used, for a maximum of 30 s, to decrease preload while the SVV and PPV measurements were repeated. Values of CA rt were calculated as SV/PP. 3. Intrapulmonary LPS increased CA rt and SV. Values of SVV and PPV increased in both LPS-treated and untreated rats during balloon inflation. There was a correlation between SVV and PPV in untreated rats before (r = 0.55; P = 0.005) and during (r = 0.69; P < 0.001) occlusion of the vena cava. There was no such correlation in LPS-treated rats either before (r = -0.08; P = 0.70) or during (r = 0.36; P = 0.08) vena cava occlusion. 4. In conclusion, under normovolaemic and hypovolaemic conditions, PPV does not reflect SVV during an increase in CA rt following LPS-induced pneumonia in mechanically ventilated rats. Our data caution against their interchangeability in human sepsis.
摘要
  1. 本研究旨在探讨在总动脉顺应性(CA rt )增加的情况下,中心测量的每搏量变异(SVV)与外周衍生的脉搏压变异(PPV)之间的关系。

  2. 10 只雄性 Wistar 大鼠在麻醉、麻痹和机械通气后,随机接受肺内脂多糖(LPS)或不接受 LPS。通过左侧颈总动脉测量脉搏压(PP),直接测量左心室的每搏量(SV)。在三个呼吸周期中计算 SVV 和 PPV 的值。通过向位于下腔静脉的导管充气(最大 30 秒)来降低前负荷,同时重复测量 SVV 和 PPV。CA rt 的值通过 SV/PP 计算。

  3. 肺内 LPS 增加 CA rt 和 SV。在 LPS 处理和未处理的大鼠中,在气球充气期间,SVV 和 PPV 的值都增加了。在未处理的大鼠中,在腔静脉闭塞之前(r = 0.55;P = 0.005)和期间(r = 0.69;P < 0.001),SVV 和 PPV 之间存在相关性。在 LPS 处理的大鼠中,在腔静脉闭塞之前(r = -0.08;P = 0.70)或期间(r = 0.36;P = 0.08)均无相关性。

  4. 总之,在机械通气的 LPS 诱导性肺炎大鼠中,在 CA rt 增加的情况下,在正常血容量和低血容量条件下,PPV 并不反映 SVV。我们的数据提醒人们,在人类脓毒症中,它们不能互换使用。

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