Ahmad Rana Altaf, Ahmad Suhail, Naveed Anjum, Baig Mirza Ahmad Raza
Prof. Dr. Rana Altaf Ahmad, DA, FCPS, M. Sc. Pain Medicine, Executive Director, Professor of Anesthesia and Critical Care, CPE Institute of Cardiology, Multan, Pakistan.
Dr. Suhail Ahmad, DA, MCPS, FCPS, M. Sc. Pain Medicine, Associate Professor of Anesthesia and Critical Care, CPE Institute of Cardiology, Multan, Pakistan.
Pak J Med Sci. 2017 Mar-Apr;33(2):310-314. doi: 10.12669/pjms.332.12220.
To determine the accuracy of peripheral (radial) arterial access as compared to central (femoral) arterial access for measurement of invasive blood pressure (IBP) in critically ill patients after cardiopulmonary bypass.
Sixty patients (60) who required high inotropic/vasopressor support on weaning from cardio-pulmonary bypass and weaned off in 2 attempt were included in this study. The duration of this study was from June 2015 to August 2016. Radial and femoral arterial access was achieved in all patients for simultaneous measurement of blood pressure. Arterial pressures were noted after 5, 15 and 30 minutes of weaning from cardiopulmonary bypass for both radial and femoral artery simultaneously.
Mean age of study patients was 56.48±11.17 years. 85% patients were male. There was significant difference in systolic blood pressure, diastolic blood pressure and mean arterial pressures between the radial artery and femoral artery cannulation. Mean arterial pressures were significantly high in femoral artery as compared to the radial artery. The mean arterial pressures after five minutes of weaning using central access were 76.28±10.21 mmHg versus 64.15±6.76 mmHg in peripheral arterial access (p-value <0.001). Similarly we also found significant difference in mean arterial pressures after 15 minutes of weaning from cardiopulmonary bypass 78.70±10.12 mmHg in central access versus 72.03±6.76 mmHg using peripheral arterial access (p-value <0.001). The difference in arterial pressures were less marked as compared to the previous differences after 30 minutes of weaning from cardiopulmonary bypass as compared to the earlier readings (p-value 0.001).
Peripheral arterial pressures are unreliable in critically ill patients after cardiopulmonary bypass receiving high dose of inotropic drugs. Central arterial access should be used in these patients to get accurate estimates of patients' blood pressure in early periods after cardiopulmonary bypass.
比较外周（桡动脉）动脉通路与中心（股动脉）动脉通路在体外循环后重症患者有创血压（IBP）测量中的准确性。
本研究纳入60例在体外循环撤机时需要高剂量正性肌力药/血管升压药支持且经过2次尝试撤机成功的患者。研究时间为2015年6月至2016年8月。所有患者均建立桡动脉和股动脉通路以同时测量血压。在体外循环撤机后5分钟、15分钟和30分钟时，同时记录桡动脉和股动脉的动脉压。
研究患者的平均年龄为56.48±11.17岁。85%为男性。桡动脉置管和股动脉置管之间的收缩压、舒张压和平均动脉压存在显著差异。与桡动脉相比，股动脉的平均动脉压显著更高。使用中心通路在撤机5分钟后的平均动脉压为76.28±10.21 mmHg，而外周动脉通路为64.15±6.76 mmHg（p值<0.001）。同样，我们还发现在体外循环撤机15分钟后，中心通路的平均动脉压为78.70±10.12 mmHg，而使用外周动脉通路为72.03±6.76 mmHg（p值<0.001）。与体外循环撤机30分钟时相比，与早期读数相比，动脉压差异不如之前明显（p值0.001）。
在接受高剂量正性肌力药物的体外循环后重症患者中，外周动脉压不可靠。这些患者应使用中心动脉通路，以便在体外循环后的早期准确估计患者血压。
