Hayabuchi Yasunobu, Ono Akemi, Homma Yukako, Kagami Shoji
Department of Pediatrics, Tokushima University, Tokushima, Japan.
Pulm Circ. 2017 Jul-Sep;7(3):666-673. doi: 10.1177/2045893217714781. Epub 2017 Jun 16.
We hypothesized that K, a harmonic oscillator kinematics-derived spring constant parameter of the pulmonary artery pressure (PAP) profile, reflects PA compliance in pediatric patients. In this prospective study of 33 children (age range = 0.5-20 years) with various cardiac diseases, we assessed the novel parameter designated as K calculated using the pressure phase plane and the equation K = (dP/dt_max)/([Pmax - Pmin])/2), where dP/dt_max is the peak derivative of PAP, and Pmax - Pmin is the difference between the minimum and maximum PAP. PA compliance was also calculated using two conventional methods: systolic PA compliance (sPAC) was expressed as the stroke volume/Pmax - Pmin; and diastolic PA compliance (dPAC) was determined according to a two-element Windkessel model of PA diastolic pressure decay. In addition, data were recorded during abdominal compression to determine the influence of preload on K. A significant correlation was observed between K and sPAC (r = 0.52, P = 0.0018), but not dPAC. Significant correlations were also seen with the time constant (τ) of diastolic PAP (r = -0.51, P = 0.0026) and the pulmonary vascular resistance index (r = -0.39, P = 0.0242). No significant difference in K was seen between before and after abdominal compression. K had a higher intraclass correlation coefficient than other compliance and resistance parameters for both intra-observer and inter-observer variability (0.998 and 0.997, respectively). These results suggest that K can provide insight into the underlying mechanisms and facilitate the quantification of PA compliance.
我们假设K是肺动脉压力(PAP)曲线中通过谐波振荡器运动学得出的弹簧常数参数,它反映了儿科患者的肺动脉顺应性。在这项针对33名患有各种心脏疾病的儿童(年龄范围为0.5 - 20岁)的前瞻性研究中,我们评估了一个新参数K,它是使用压力相平面和公式K = (dP/dt_max)/([Pmax - Pmin])/2计算得出的,其中dP/dt_max是PAP的峰值导数,Pmax - Pmin是最小和最大PAP之间的差值。肺动脉顺应性也使用两种传统方法进行计算:收缩期肺动脉顺应性(sPAC)表示为每搏量/(Pmax - Pmin);舒张期肺动脉顺应性(dPAC)根据肺动脉舒张压衰减的双元件Windkessel模型确定。此外,在腹部加压期间记录数据以确定前负荷对K的影响。观察到K与sPAC之间存在显著相关性(r = 0.52,P = 0.0018),但与dPAC无相关性。与舒张期PAP的时间常数(τ)(r = -0.51,P = 0.0026)和肺血管阻力指数(r = -0.39,P = 0.0242)也存在显著相关性。腹部加压前后K没有显著差异。对于观察者内和观察者间的变异性,K的组内相关系数均高于其他顺应性和阻力参数(分别为0.998和0.997)。这些结果表明,K可以深入了解潜在机制并有助于量化肺动脉顺应性。