Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, 210029 Nanjing, Jiangsu, China.
Department of Cardiothoracic and vascular surgery, Nanjing First Hospital, Nanjing Medical University, 210029 Nanjing, Jiangsu, China.
Heart Surg Forum. 2023 May 31;26(3):E234-E239. doi: 10.1532/hsf.5465.
In general, cerebral blood flow accounts for 10-15% of cardiac output (CO), of which about 75% is delivered through the carotid arteries. Hence, if carotid blood flow (CBF) is constantly proportional to CO with high reproducibility and reliability, it would be of great value to measure CBF as an alternative to CO. The aim of this study was to investigate the direct correlation between CBF and CO. We hypothesized that measurement of CBF could be a good substitute for CO, even under more extreme hemodynamic conditions, for a wider range of critically ill patients.
Patients aged 65-80 years, undergoing elective cardiac surgery were included in this study. CBF in different cardiac cycles were measured by ultrasound: systolic carotid blood flow (SCF), diastolic carotid blood flow (DCF), and total (systolic and diastolic) carotid blood flow (TCF). CO simultaneously was measured by transesophageal echocardiography.
For all patients, the correlation coefficients between SCF and CO, TCF and CO were 0.45 and 0.30, respectively, which were statistically significant, but not between DCF and CO. There was no significant correlation between either SCF, TCF or DCF and CO, when CO was <3.5 L/min.
Systolic carotid blood flow may be used as a better index to replace CO. However, the method of direct measurement of CO is essential when the patient's heart function is poor.
一般来说,大脑血流占心输出量(CO)的 10-15%,其中约 75%通过颈动脉供应。因此,如果颈动脉血流(CBF)与 CO 具有高度的可重复性和可靠性,并且能够持续成比例,那么测量 CBF 作为 CO 的替代指标将具有重要意义。本研究旨在探讨 CBF 与 CO 之间的直接相关性。我们假设,即使在更极端的血流动力学条件下,测量 CBF 也可以作为 CO 的良好替代指标,适用于更广泛的危重症患者。
本研究纳入了年龄在 65-80 岁之间的择期行心脏手术的患者。通过超声测量不同心动周期的 CBF:收缩期颈动脉血流(SCF)、舒张期颈动脉血流(DCF)和总颈动脉血流(TCF)。同时通过经食管超声心动图测量 CO。
对于所有患者,SCF 与 CO、TCF 与 CO 的相关系数分别为 0.45 和 0.30,均具有统计学意义,但 DCF 与 CO 之间无显著相关性。当 CO<3.5 L/min 时,无论是 SCF、TCF 还是 DCF 与 CO 之间均无显著相关性。
收缩期颈动脉血流可能是替代 CO 的更好指标。然而,当患者心功能较差时,直接测量 CO 的方法是必不可少的。