Becker H, Brinkmann H, Allenberg J R
Chirurg. 1985 Aug;56(8):522-7.
The operative mortality in abdominal aortic aneurysm repair is in large part attributable to a high incidence of myocardial infarction. This is a result of cardiovascular instability during aortic cross-clamping and declamping in patients with coexistent coronary artery disease. Therefore cardiodynamics (pulmonary arterial wedge pressure, PAWP; cardiac index, CJ) were studied in 31 patients during abdominal aortic aneurysm surgery. 12 patients (control) with a PAWP mean of 8 mmHg preoperatively showed impaired cardiac function after declamping and a significant fall in arterial pressure. 19 patients were volume loaded to a PAWP greater than 12 mmHg and the cyclo-oxygenase inhibitor Aspirin was given preoperatively. This resulted in improved cardiac performance with no fall in arterial pressure after declamping. Optimal volume loading and cyclo-oxygenase inhibition have the ability to prevent adverse hemodynamic responses to aortic clamping and declamping. Maintenance of optimal cardiac performance will reduce cardiovascular complications and postoperative mortality in abdominal aortic aneurysm repair.
腹主动脉瘤修复术中的手术死亡率在很大程度上归因于心肌梗死的高发生率。这是由于存在冠状动脉疾病的患者在主动脉交叉钳夹和松开期间心血管不稳定所致。因此，在31例腹主动脉瘤手术患者中研究了心脏动力学（肺动脉楔压，PAWP；心脏指数，CI）。12例术前PAWP平均为8 mmHg的患者（对照组）在松开钳夹后心脏功能受损，动脉压显著下降。19例患者进行容量负荷使PAWP大于12 mmHg，并在术前给予环氧化酶抑制剂阿司匹林。这导致心脏功能改善，松开钳夹后动脉压未下降。最佳容量负荷和环氧化酶抑制能够预防对主动脉钳夹和松开的不良血流动力学反应。维持最佳心脏功能将降低腹主动脉瘤修复术中的心血管并发症和术后死亡率。
