Bloechlinger Stefan, Berger David, Bryner Jürg, Roost Eva, Jakob Stephan, Dünser Martin W, Takala Jukka
Department of Intensive Care Medicine, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland; Department of Cardiology, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland.
Department of Intensive Care Medicine, Inselspital, University Hospital Bern & University of Bern, Bern, Switzerland.
J Cardiothorac Vasc Anesth. 2015 Aug;29(4):860-7. doi: 10.1053/j.jvca.2015.01.010. Epub 2015 Jan 8.
In patients with aortic stenosis, left ventricular systolic torsion (pT) is increased to overcome excessive afterload. This study assessed left ventricular torsion before and immediately after surgical valve replacement and tested the instant effect of fluid loading.
Prospective, clinical single-center study.
Intensive care unit of a university hospital.
12 patients undergoing elective aortic valve replacement for aortic stenosis.
Echocardiography was performed on the day before surgery, within 18 hours after surgery including a fluid challenge, and after 2.5 years.
pT decreased early postoperatively by 21.2% (23.4° ± 5.6° to 18.4° ± 6.9°; p = 0.012) and reached preoperative values at 2.5 years follow-up (24 ± 7). Peak diastolic untwisting velocity occurred later early postoperatively (13% ± 8% to 21% ± 9.4%; p = 0.019) and returned toward preoperative values at follow-up (10.2 ± 4.7°). The fluid challenge increased central venous pressure (8 ± 4 mmHg to 11 ± 4 mmHg; p = 0.003) and reduced peak systolic torsion velocity (138.7 ± 37.6/s to 121.3 ± 32/s; p = 0.032). pT decreased in 3 and increased in 8 patients after fluid loading. Patients whose pT increased had higher early mitral inflow velocity postoperatively (p = 0.04) than those with decreasing pT. Patients with reduced pT after fluid loading received more fluids (p = 0.04) and had a higher positive fluid balance during the intensive care unit stay (p = 0.03). Torsion after fluid loading correlated with total fluid input (p = 0.001) and cumulative fluid balance (p = 0.002).
pT decreased early after aortic valve replacement but remained elevated despite elimination of aortic stenosis. After 2.5 years, torsion had returned to preoperative levels.
在主动脉瓣狭窄患者中，左心室收缩期扭转（pT）增加以克服过高的后负荷。本研究评估了手术瓣膜置换术前及术后即刻的左心室扭转情况，并测试了液体负荷的即时效应。
前瞻性临床单中心研究。
大学医院重症监护病房。
12例因主动脉瓣狭窄接受择期主动脉瓣置换术的患者。
在手术前一天、术后18小时内（包括液体负荷试验）以及2.5年后进行超声心动图检查。
术后早期pT下降21.2%（从23.4°±5.6°降至18.4°±6.9°；p = 0.012），并在2.5年随访时达到术前值（24±7）。舒张期最大解旋速度在术后早期出现延迟（从13%±8%增至21%±9.4%；p = 0.019），随访时恢复至术前值（10.2±4.7°）。液体负荷试验使中心静脉压升高（从8±4 mmHg升至11±4 mmHg；p = 0.003），并降低了收缩期最大扭转速度（从138.7±37.6/s降至121.3±32/s；p = 0.032）。液体负荷后，3例患者的pT下降，8例患者的pT升高。pT升高的患者术后早期二尖瓣流入速度高于pT降低的患者（p = 0.04）。液体负荷后pT降低的患者接受了更多液体（p = 0.04），且在重症监护病房住院期间液体正平衡更高（p = 0.03）。液体负荷后的扭转与总液体输入量（p = 0.001）和累积液体平衡（p = 0.002）相关。
主动脉瓣置换术后早期pT下降，但尽管消除了主动脉瓣狭窄，其仍处于升高状态。2.5年后，扭转已恢复至术前水平。
