Ranganathan N, Sivaciyan V, Pryszlak M, Freeman M R
Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
Am J Cardiol. 1989 Mar 15;63(11):725-9. doi: 10.1016/0002-9149(89)90259-2.
The factors underlying postoperative jugular venous flow velocity and pulse contour changes were studied in 25 patients undergoing coronary artery bypass grafting. Before operation, all patients had normal right-sided cardiac hemodynamics, normal jugular pulse contours and normal jugular venous flow velocity patterns, i.e., systolic flow (SF) velocity greater than diastolic flow (DF) velocity. After operation, jugular venous flow velocity was abnormal in 24 patients (SF = DF in 14 and SF less than DF in 10). Neither the right-sided cardiac pressures after the operation nor any of the perioperative factors examined had any bearing on these flow alterations. Postoperative right ventricular ejection fraction was normal in all 5 patients with SF greater than DF and SF = DF flow patterns (mean +/- standard error of the mean 48 +/- 3%). It was significantly depressed in all 6 patients with SF less than DF flow pattern (34 +/- 1%, 2p less than 0.001). These findings suggest that the right atrium behaves as a conduit rather than a capacitance chamber. However, the postoperative abnormal flow pattern of SF less than DF as opposed to SF = DF indicates the additional presence of right ventricular dysfunction. The implications of these observations for the clinical assessment of right ventricular function in the postoperative patients are discussed.
对25例接受冠状动脉旁路移植术的患者术后颈静脉血流速度和脉搏轮廓变化的潜在因素进行了研究。术前，所有患者右侧心脏血流动力学正常，颈静脉脉搏轮廓正常，颈静脉血流速度模式正常，即收缩期血流（SF）速度大于舒张期血流（DF）速度。术后，24例患者颈静脉血流速度异常（14例SF = DF，10例SF小于DF）。术后右侧心脏压力以及所检查的任何围手术期因素均与这些血流改变无关。在所有5例SF大于DF和SF = DF血流模式的患者中，术后右心室射血分数正常（平均值±平均值标准误差为48±3%）。在所有6例SF小于DF血流模式的患者中，右心室射血分数显著降低（34±1%，P<0.001）。这些发现表明右心房表现为一个管道而非一个容量腔。然而，与SF = DF相反，术后出现的SF小于DF的异常血流模式表明还存在右心室功能障碍。讨论了这些观察结果对术后患者右心室功能临床评估的意义。
