Department of Anesthesiology and Critical Care, Hôpitaux Universitaires Saint-Louis-Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, 2 rue Ambroise-Paris, 75475, Paris Cedex 10, France.
Inserm, UMRS-942, Paris Diderot University, Paris, France.
J Clin Monit Comput. 2019 Aug;33(4):581-587. doi: 10.1007/s10877-018-0210-8. Epub 2018 Oct 25.
Cardiac output (CO) optimisation during surgery reduces post-operative morbidity. Various methods based on pulse pressure analysis have been developed to overcome difficulties to measure accurate CO variations in standard anaesthetic settings. Several of these methods include, among other parameters, the ratio of pulse pressure to mean arterial pressure (PP/MAP). The aim of this study was to evaluate whether the ratio of radial pulse pressure to mean arterial pressure (ΔPPrad/MAP) could track CO variations (ΔCO) induced by various therapeutic interventions such as fluid infusions and vasopressors boluses [phenylephrine (PE), norepinephrine (NA) or ephedrine (EP)] in the operating room. Trans-oesophageal Doppler signal and pressure waveforms were recorded in patients undergoing neurosurgery. CO and PPrad/MAP were recorded before and after fluid challenges, PE, NA and EP bolus infusions as medically required during their anaesthesia. One hundred and three patients (mean age: 52 ± 12 years old, 38 men) have been included with a total of 636 sets of measurement. During fluids challenges (n = 188), a positive correlation was found between ΔPPrad/MAP and ΔCO (r = 0.22, p = 0.003). After PE (n = 256) and NA (n = 121) boluses, ΔPPrad/MAP positively tracked ΔCO (r = 0.53 and 0.41 respectively, p < 0.001). By contrast, there was no relation between ΔPPrad/MAP and ΔCO after EP boluses (r = 0.10, p = 0.39). ΔPPrad/MAP tracked ΔCO variations during PE and NA vasopressor challenges. However, after positive fluid challenge or EP boluses, ΔPPrad/MAP was not as performant to track ΔCO which could make the use of this ratio difficult in current clinical practice.
心输出量（CO）在手术中的优化可降低术后发病率。已经开发出各种基于脉搏压分析的方法来克服在标准麻醉环境下准确测量 CO 变化的困难。这些方法中的几种包括，除其他参数外，脉搏压与平均动脉压（PP/MAP）的比值。本研究旨在评估在手术室中，桡动脉脉搏压与平均动脉压（ΔPPrad/MAP）的比值是否可以跟踪各种治疗干预（如液体输注和血管加压药推注[苯肾上腺素（PE）、去甲肾上腺素（NA）或麻黄碱（EP）]引起的 CO 变化（ΔCO）。在接受神经外科手术的患者中记录经食管多普勒信号和压力波形。在麻醉期间根据需要输注 PE、NA 和 EP 推注前后记录 CO 和 PPrad/MAP。共纳入 103 例患者（平均年龄：52±12 岁，38 名男性），共进行了 636 次测量。在液体挑战期间（n=188），发现 ΔPPrad/MAP 与 ΔCO 之间存在正相关（r=0.22，p=0.003）。在 PE（n=256）和 NA（n=121）推注后，ΔPPrad/MAP 可正向跟踪 ΔCO（r=0.53 和 0.41，分别为 p<0.001）。相比之下，在 EP 推注后，ΔPPrad/MAP 与 ΔCO 之间没有关系（r=0.10，p=0.39）。ΔPPrad/MAP 在 PE 和 NA 血管加压药挑战期间跟踪 ΔCO 变化。然而，在正液挑战或 EP 推注后，ΔPPrad/MAP 无法很好地跟踪 ΔCO，这使得在当前临床实践中使用该比值变得困难。
