Douglas P S, Edmunds L H, Sutton M S, Geer R, Harken A H, Reichek N
Ann Thorac Surg. 1987 Jul;44(1):31-4. doi: 10.1016/s0003-4975(10)62352-1.
Pulmonary artery diastolic (PADP) and wedge pressures (PAWP) and left ventricular end-diastolic pressure (LVEDP) are commonly used to estimate left ventricular (LV) preload. To assess the ability of hemodynamic indexes of preload to estimate anatomical preload, or LV volume, we studied 45 patients during a coronary (18 patients) or aortic valve (27 patients) procedure and compared epicardial two-dimensional echocardiographic LV cavity area with simultaneous measurements of PADP, PAWP, and high-fidelity LVEDP. Pulmonary artery diastolic pressure, PAWP, and their percent change after bypass did not correlate with absolute values (before or after bypass) or percent change in LVEDP. Percent change in LV area correlated weakly with percent change in PADP (r = .34, p less than .03) but not with changes in PAWP or LVEDP. Changes were opposite in direction in 45% (PADP), 50% (PAWP), and 67% (LVEDP) of patients. In conclusion, both PADP and PAWP were poor guides to LVEDP and neither reflected changes in LV size. Thus, hemodynamic indexes of preload should be used with caution during cardiac operations.
肺动脉舒张压（PADP）、楔压（PAWP）和左心室舒张末期压力（LVEDP）常用于评估左心室（LV）前负荷。为了评估前负荷的血流动力学指标对解剖学前负荷或左心室容积的评估能力，我们在45例接受冠状动脉（18例）或主动脉瓣（27例）手术的患者中进行了研究，并将心外膜二维超声心动图测量的左心室腔面积与同时测量的PADP、PAWP和高保真LVEDP进行了比较。肺动脉舒张压、PAWP及其在体外循环后的变化百分比与（体外循环前后的）绝对值或LVEDP的变化百分比均无相关性。左心室面积的变化百分比与PADP的变化百分比弱相关（r = 0.34，p < 0.03），但与PAWP或LVEDP的变化无关。在45%（PADP）、50%（PAWP）和67%（LVEDP）的患者中，变化方向相反。总之，PADP和PAWP都不是LVEDP的良好指标，也都不能反映左心室大小的变化。因此，在心脏手术期间应谨慎使用前负荷的血流动力学指标。
