Wilson R F, Beckman S B, Tyburski J G, Scholten D J
Department of Surgery, Detroit Receiving Hospital, Mich.
Arch Surg. 1988 Aug;123(8):933-6. doi: 10.1001/archsurg.1988.01400320019002.
To study pulmonary artery wedge pressure (PAWP) and pulmonary artery diastolic pressure (PADP) relationships, we measured these simultaneously with cardiac outputs 1922 times in 128 patients who were critically ill or in an intensive care unit. In 356 (18.5%) of the readings, the PAWP exceeded the PADP, indicating that the PAWP reading might be erroneous. In 106 (5.5%) of these readings, the PAWP was 6.0 mm Hg or more higher than the PADP, indicating that the PAWP was almost certainly erroneous. In virtually all instances in which this discrepancy was recognized, changing the position of the catheter tip provided a PAWP value equal to or lower than the PADP. On the other extreme, in 49 (30%) of the patients, the PADP was 6.0 mm Hg or more higher than the PAWP. The pulmonary vascular resistance in these patients averaged (+/- SD) 257 +/- 145 dyne/s/cm-5 (normal, 80 to 160 dyne/s/cm-5). The mean pulmonary vascular resistance in the other 74 patients was significantly lower (158 +/- 72 dyne/s/cm-5). The mortality rate with the increased PADP-PAWP gradients was 59% (24/49). This was significantly higher than the mortality rate (34%, or 27/79) seen with lower PAWP-PADP gradients. Thus, the relationship between the PADP and PAWP should be examined closely in critically ill patients. A PAWP higher than the PADP indicates that the PAWP measurement may be erroneous. On the other hand, if the PADP exceeds the PAWP by 6.0 mm Hg or more, the patient has probably developed pulmonary hypertension and has a much poorer prognosis.
为研究肺动脉楔压（PAWP）与肺动脉舒张压（PADP）之间的关系，我们对128例重症或在重症监护病房的患者进行了1922次心输出量与这些指标的同步测量。在356次（18.5%）读数中，PAWP超过了PADP，这表明PAWP读数可能有误。在其中106次（5.5%）读数中，PAWP比PADP高6.0 mmHg或更多，这表明PAWP几乎肯定有误。在几乎所有识别出这种差异的情况下，改变导管尖端位置可得到等于或低于PADP的PAWP值。另一方面，在49例（30%）患者中，PADP比PAWP高6.0 mmHg或更多。这些患者的肺血管阻力平均为（±标准差）257±145达因/秒/厘米⁵（正常为80至160达因/秒/厘米⁵）。其他74例患者的平均肺血管阻力显著更低（158±72达因/秒/厘米⁵）。PADP - PAWP梯度增加时的死亡率为59%（24/49）。这显著高于PAWP - PADP梯度较低时的死亡率（34%，即27/79）。因此，对于重症患者应密切检查PADP与PAWP之间的关系。PAWP高于PADP表明PAWP测量可能有误。另一方面，如果PADP超过PAWP 6.0 mmHg或更多，患者可能已发生肺动脉高压且预后差得多。
