前负荷依赖性决定去氧肾上腺素对麻醉患者心输出量的影响：一项前瞻性观察性研究。

Preload dependency determines the effects of phenylephrine on cardiac output in anaesthetised patients: A prospective observational study.

作者信息

Rebet Olivier, Andremont Olivier, Gérard Jean-Louis, Fellahi Jean-Luc, Hanouz Jean-Luc, Fischer Marc-Olivier

机构信息

From the Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre (OR, OA, J-LG, J-LH, M-OF); Université de Caen Basse-Normandie, Esplanade de la Paix, Caen, France (J-LH, M-OF); Service d'Anesthésie-Réanimation, Hôpital Cardiologique Louis Pradel, Avenue du Doyen Lepine, (J-LF); and Faculty of Medicine, University of Lyon, Lyon, France (J-LF).

出版信息

Eur J Anaesthesiol. 2016 Sep;33(9):638-44. doi: 10.1097/EJA.0000000000000470.

DOI:10.1097/EJA.0000000000000470

PMID:27164015

Abstract

BACKGROUND

Although phenylephrine is widely used in the operating room to control arterial pressure, its haemodynamic effects remain controversial.

OBJECTIVE

We hypothesised that the effect of phenylephrine on cardiac output is affected by preload dependency.

DESIGN

A prospective observational study.

SETTING

Single-centre, University Hospital of Caen, France.

PATIENTS

Fifty ventilated patients undergoing surgery were studied during hypotension before and after administration of phenylephrine.

MAIN OUTCOME MEASURES

Cardiac index (CI), stroke volume (SV), corrected flow time, mean arterial pressure, pulse pressure variations (PPV) and systemic vascular resistance index were used to assess effects of changes in preload dependency.

RESULTS

Twenty seven (54%) patients were included in the preload-dependent group (PPV ≥ 13%) and 23 (46%) in the preload-independent group (PPV < 13%) before administration of phenylephrine. For the whole cohort, phenylephrine increased mean arterial pressure [58 (±8) mmHg vs. 79 (±13) mmHg; P < 0.0001] and calculated systemic vascular resistance index [2010 (1338; 2481) dyn s cm m vs. 2989 (2155; 3870) dyn s cm m; P < 0.0001]. However, CI and SV decreased in the preload-independent group [2.3 (1.9; 3.7) l min m vs. 1.8 (1.5; 2.7) l min m; P < 0.0001 and 65 (44; 81) ml vs. 56 (39; 66) ml; P < 0.0001 for both] but not in the preload-dependent group [respectively 2.1 (1.8; 3.5) l min m vs. 2.1 (1.8; 3.3) l min m; P = 0.168 and 49 (41; 67) ml vs. 53 (41; 69) ml; P = 0.191]. Corrected flow time increased [294 (47) ms vs. 306 (56) ms; P = 0.031], and PPV decreased [17 (15; 19) % vs.12 (14; 16) %; P < 0.0003] only in the PPV at least 13% group.

CONCLUSION

The effects of phenylephrine on CI and SV depend on preload. CI and SV decreased in preload-independent patients through increase in afterload, but were unchanged in those preload-dependent through increased venous return.

摘要

背景

尽管去氧肾上腺素在手术室中被广泛用于控制动脉血压，但其血流动力学效应仍存在争议。

目的

我们假设去氧肾上腺素对心输出量的影响受前负荷依赖性的影响。

设计

一项前瞻性观察性研究。

地点

法国卡昂大学医院单中心。

患者

50例接受手术的机械通气患者在使用去氧肾上腺素前后的低血压期间接受研究。

主要观察指标

使用心脏指数（CI）、每搏量（SV）、校正血流时间、平均动脉压、脉压变异（PPV）和全身血管阻力指数来评估前负荷依赖性变化的影响。

结果

在使用去氧肾上腺素之前，27例（54%）患者被纳入前负荷依赖性组（PPV≥13%），23例（46%）被纳入前负荷非依赖性组（PPV<13%）。对于整个队列，去氧肾上腺素增加了平均动脉压[58（±8）mmHg对79（±13）mmHg；P<0.0001]和计算得出的全身血管阻力指数[2010（1338；2481）dyn s cm m对2989（2155；3870）dyn s cm m；P<0.0001]。然而，前负荷非依赖性组中的CI和SV降低了[2.3（1.9；3.7）l min m对1.8（1.5；2.7）l min m；P<0.0001，两者的每搏量分别为65（44；81）ml对56（39；66）ml；P<0.0001]，而在前负荷依赖性组中则没有变化[分别为2.1（1.8；3.5）l min m对2.1（1.8；3.3）l min m；P = 0.168，每搏量为49（41；67）ml对53（41；69）ml；P = 0.191]。仅在PPV至少为13%的组中，校正血流时间增加了[294（47）ms对306（56）ms；P = 0.031]，PPV降低了[17（15；19）%对12（14；16）%；P<0.0003]。