Hardy J D, Garcia J B, Hardy J A, Harkins M H
Ann Surg. 1974 Aug;180(2):162-6. doi: 10.1097/00000658-197408000-00006.
The effects of dextran overload, norepinephrine drip and positive pressure ventilation upon right atrial, pulmonary wedge, left atrial and systemic arterial pressures were studied in 15 dogs. Rapid intravenous infusion of Dextran 70 invariably produced a marked and statistically significant (p < .001) rise in right atrial, pulmonary wedge and left atrial pressures. The rise in left atrial pressure invariably exceeded the rise in right atrial pressure, and the difference in maximum pressures averaged 10.8 mm Hg (p < .001). Thus acute fluid overload and pulmonary edema can be produced by rapid infusion of colloid solution in the absence of a marked rise in right atrial pressure, a point of considerable clinical importance. The rapid infusion of dextran produced a rise in systemic arterial blood pressure in all dogs so studied, though this rise was mild in some animals. This finding may explain in part the hypertension exhibited by patients in the recovery room who may have been overtransfused. A norepinephrine drip usually produced an increase in right atrial, wedge, left atrial and systemic arterial blood pressure (p < .01). When there was a significant rise in right atrial pressure and left atrial pressure, the maximum increase in left atrial pressure was always greater than the maximum increase in right atrial pressure (p < .005). This finding again emphasizes the fact that blood transfusion requirements cannot always be accurately assessed on the basis of right and left atrial pressure measurements when a vasopressor agent is being administered. Positive pressure ventilation increased both right and left atrial pressures, as expected. It was again confirmed that pulmonary wedge pressure, as measured with the Swan-Ganz catheter, is approximately equal to left atrial pressure over a wide range of induced variations. The Swan-Ganz catheter, introduced at the bedside in the intensive care unit when necessary, can provide highly useful information regarding left atrial pressure and left ventricular end-diastolic pressure.
在15只犬身上研究了右旋糖酐过量、去甲肾上腺素滴注和正压通气对右心房、肺楔压、左心房和体动脉压的影响。快速静脉输注右旋糖酐70总是会导致右心房、肺楔压和左心房压力显著升高，且具有统计学意义（p <.001）。左心房压力的升高总是超过右心房压力的升高，最大压力差平均为10.8 mmHg（p <.001）。因此，在右心房压力没有显著升高的情况下，快速输注胶体溶液可导致急性液体过载和肺水肿，这一点具有相当重要的临床意义。在所研究的所有犬中，快速输注右旋糖酐都会使体动脉血压升高，尽管在一些动物中这种升高较为轻微。这一发现可能部分解释了恢复室中可能输血过量的患者所表现出的高血压。去甲肾上腺素滴注通常会使右心房、楔压、左心房和体动脉血压升高（p <.01）。当右心房压力和左心房压力显著升高时，左心房压力的最大升高总是大于右心房压力的最大升高（p <.005）。这一发现再次强调了这样一个事实，即当使用血管升压药时，不能总是根据左右心房压力测量来准确评估输血需求。正如预期的那样，正压通气会使右心房和左心房压力均升高。再次证实，在广泛的诱导变化范围内，用Swan-Ganz导管测量的肺楔压大约等于左心房压力。必要时在重症监护病房床边插入的Swan-Ganz导管可提供有关左心房压力和左心室舒张末期压力的非常有用的信息。
