Hansen R M, Viquerat C E, Matthay M A, Wiener-Kronish J P, DeMarco T, Bahtia S, Marks J D, Botvinick E H, Chatterjee K
Anesthesiology. 1986 Jun;64(6):764-70. doi: 10.1097/00000542-198606000-00015.
The authors studied 12 surgical patients in the intensive care unit post coronary artery bypass graft surgery and ten nonsurgical patients in the coronary care unit with chronic heart failure to determine the usefulness of the pulmonary arterial wedge pressure as an indicator of left ventricular preload. Left ventricular end diastolic volume was derived from concomitant determination of ejection fraction (gated blood pool scintigraphy) and stroke volume (determined from thermodilution cardiac output). In the nonsurgical patients, there was a significant correlation between changes in pulmonary arterial wedge pressure and left ventricular end-diastolic volume (P less than 0.05, r = 0.57). In the 12 patients studied during the first few hours after surgery, there was a poor correlation between changes in pulmonary wedge pressure (range = 4-32 mmHg) and left ventricular end-diastolic volume (range = 25-119 ml/m2), and a poor correlation between pulmonary arterial wedge pressures and stroke work index. In contrast, there was a good correlation between left ventricular end-diastolic volume and stroke work index. The poor correlation between the pulmonary arterial wedge pressure and left ventricular end-diastolic volume was not explained by changes in systemic or pulmonary vascular resistance. The altered ventricular pressure-volume relationship may reflect acute changes in ventricular compliance in the first few hours following coronary artery bypass graft surgery. While measurement of pulmonary arterial wedge pressure remains valuable in clinical management to avoid pulmonary edema, it cannot reliably be used as an index of left ventricular preload while attempting to optimize stroke volume in patients immediately following coronary artery bypass graft surgery.
作者对12例冠状动脉搭桥术后重症监护病房的外科患者以及10例冠心病监护病房中患有慢性心力衰竭的非外科患者进行了研究，以确定肺动脉楔压作为左心室前负荷指标的有效性。左心室舒张末期容积通过同时测定射血分数（门控心血池闪烁显像）和每搏量（根据热稀释心输出量测定）得出。在非外科患者中，肺动脉楔压变化与左心室舒张末期容积之间存在显著相关性（P<0.05，r = 0.57）。在术后最初几小时研究的12例患者中，肺楔压变化（范围 = 4 - 32 mmHg）与左心室舒张末期容积（范围 = 25 - 119 ml/m²）之间相关性较差，肺动脉楔压与每搏功指数之间相关性也较差。相比之下，左心室舒张末期容积与每搏功指数之间存在良好相关性。肺动脉楔压与左心室舒张末期容积之间的较差相关性无法用体循环或肺循环血管阻力的变化来解释。心室压力 - 容积关系的改变可能反映了冠状动脉搭桥术后最初几小时内心室顺应性的急性变化。虽然测量肺动脉楔压在临床管理中对于避免肺水肿仍然很有价值，但在试图优化冠状动脉搭桥术后即刻患者的每搏量时，它不能可靠地用作左心室前负荷的指标。
