Kowalski S, Downs A R, Lye C, Oppenheimer L
Department of Surgery, University of Manitoba, Winnipeg.
Can J Anaesth. 1989 May;36(3 Pt 1):283-8. doi: 10.1007/BF03010766.
Cross-clamping of the abdominal aorta can be associated with significant changes in haemodynamic variables. However, intraoperative changes in extravascular lung water (EVLW) have not been studied. Nine patients undergoing elective surgery, either aortic aneurysm repair or aorto-bifemoral grafting, were monitored invasively with arterial lines, pulmonary artery catheters and Edwards lung water catheters inserted in either the brachial or axillary artery. Determinations of EVLW were made prior to and five minutes after application of the aortic cross-clamp and at 30-minute intervals during the course of the operation. Baseline EVLW was found to be 7-9 ml.kg-1. There were no significant changes in haemodynamic variables and no changes in EVLW with cross-clamping of the aorta. The EVLW did not change during the course of surgery. The EVLW did not increase in the absence of sustained elevation of pulmonary capillary wedge pressure. One patient developed an axillary artery thrombosis which required thrombectomy at the site of lung water catheter insertion. Two other patients lost their distal pulses without overt ischaemic changes. It was felt that such relatively high incidence of complications precluded further use of the lung water catheter in the axillary or brachial artery.
腹主动脉交叉钳夹可能与血流动力学变量的显著变化相关。然而，血管外肺水（EVLW）的术中变化尚未得到研究。对9例行择期手术（主动脉瘤修复术或主动脉双股动脉移植术）的患者进行有创监测，通过插入肱动脉或腋动脉的动脉导管、肺动脉导管和爱德华兹肺水导管进行监测。在应用主动脉交叉钳夹前、应用后5分钟以及手术过程中每隔30分钟测定一次EVLW。发现基线EVLW为7 - 9 ml·kg⁻¹。血流动力学变量无显著变化，主动脉交叉钳夹时EVLW也无变化。手术过程中EVLW未改变。在肺毛细血管楔压未持续升高的情况下，EVLW没有增加。1例患者发生腋动脉血栓形成，需要在肺水导管插入部位进行血栓切除术。另外2例患者失去远端脉搏，但无明显缺血性改变。认为如此相对较高的并发症发生率使得肺水导管无法在腋动脉或肱动脉中进一步使用。
