Park Yong-Seok, Moon Young-Jin, Kim Sung-Hoon, Kim Jae-Man, Song Jun-Gol, Hwang Gyu-Sam
Department of Anesthesiology and Pain Medicine, Biosignal Analysis and Perioperative Outcome Research Laboratory, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.
J Clin Med. 2019 Apr 30;8(5):593. doi: 10.3390/jcm8050593.
To investigate the possibility of esophageal phonocardiography as a monitor for invasively measured pulse pressure (PP) and its respiratory variation (PPV) in patients undergoing liver transplantation.
In 24 liver transplantation recipients, all hemodynamic parameters, including PP and PPV, were measured during five predetermined surgical phases. Simultaneously, signals of esophageal heart sounds (S1, S2) were identified, and S1-S2 interval (phonocardiographic systolic time, PST) and its respiratory variation (PSV) within a 20-s window were calculated. Beat-to-beat correlation between PP and its corresponding PST was assessed during each time window, according to the surgical phases. To compare PPV and PSV along with 5 phases (a total of 120 data pairs), Pearson correlation was conducted.
Beat-to-beat PST values were closely correlated with their corresponding 3360 pairs of PP values (median = 0.568 [IQR 0.246-0.803]). Compared with the initial phase of surgery, correlation coefficients were significantly lower during the reperfusion period (median = 0.717 [IQR 0.532-0.886] vs. median = 0.346 [IQR 0.037-0.677]; = 0.002). The correlation between PSV and PPV showed similar variation according to the surgical phases ( = 0.576 to 0.689, < 0.05, for pre-reperfusion; 0.290 to 0.429 for the post-reperfusion period).
Continuous monitoring of intraoperative PST with an esophageal stethoscope has the potential to act as an indirect estimator of beat-to-beat arterial PP. Moreover, PSV appears to exhibit a trend similar to that of PPV with moderate accuracy. However, variation according to the surgical phase limits the merit of the current results, thereby necessitating cautious interpretation.
探讨食管心音图作为监测肝移植患者有创测量脉压（PP）及其呼吸变异（PPV）的可能性。
对24例肝移植受者，在五个预定手术阶段测量包括PP和PPV在内的所有血流动力学参数。同时，识别食管心音（S1、S2）信号，并计算20秒窗口内的S1 - S2间期（心音图收缩期时间，PST）及其呼吸变异（PSV）。根据手术阶段，在每个时间窗口评估PP与其相应PST之间的逐搏相关性。为比较PPV和PSV在五个阶段（共120对数据）的情况，进行Pearson相关性分析。
逐搏PST值与其相应的3360对PP值密切相关（中位数 = 0.568 [四分位间距0.246 - 0.803]）。与手术初始阶段相比，再灌注期的相关系数显著降低（中位数 = 0.717 [四分位间距0.532 - 0.886] 对中位数 = 0.346 [四分位间距0.037 - 0.677]；P = 0.002）。PSV与PPV之间的相关性根据手术阶段呈现相似变化（再灌注前为0.576至0.689，P < 0.05；再灌注后为0.290至0.429）。
用食管听诊器连续监测术中PST有可能作为逐搏动脉PP的间接估计指标。此外，PSV似乎呈现出与PPV相似的趋势，准确性中等。然而，根据手术阶段的变化限制了当前结果的价值，因此需要谨慎解读。
