Fiser W P, Thompson B W, Thompson A R, Eason C, Read R C
Surgery. 1983 Nov;94(5):736-9.
Since atherosclerotic heart disease results in more than half of the perioperative deaths that follow abdominal aortic surgery, a prospective protocol was designed for preoperative evaluation and intraoperative hemodynamic monitoring. Twenty men who were prepared to undergo elective operation for aortoiliac occlusive disease (12 patients) and abdominal aortic aneurysm (eight patients) were evaluated with a cardiac scan and right heart catheterization. The night prior to operation, each patient received volume loading with crystalloid based upon ventricular performance curves. At the time of the operation, all patients were anesthetized with narcotics and nitrous oxide, and hemodynamic parameters were recorded throughout the operation. Aortic crossclamping resulted in a marked depression in CI in all patients. CI remained depressed P less than 0.05 after unclamping in the majority of patients. There were two perioperative deaths, both from myocardial infarction or failure. Both patients had ejection fractions less than 30% and initial CIs less than 2 L/M2, while the survivors' mean ejection fraction was 63% +/- 1 and their mean CI was 3.2 L/M2 +/- 0.6. We conclude that preoperative evaluation of ejection fraction can select those patients at a high risk of cardiac death from abdominal aortic operation. These patients should receive intensive preoperative monitoring with enhancement of ventricular performance.
由于动脉粥样硬化性心脏病导致了腹主动脉手术后超过半数的围手术期死亡，因此设计了一项前瞻性方案用于术前评估和术中血流动力学监测。对20名准备接受择期手术治疗主髂动脉闭塞性疾病（12例患者）和腹主动脉瘤（8例患者）的男性患者进行了心脏扫描和右心导管检查。手术前一晚，根据心室功能曲线，为每位患者输注晶体液进行容量负荷。手术时，所有患者均用麻醉剂和一氧化二氮麻醉，并在整个手术过程中记录血流动力学参数。主动脉阻断导致所有患者的心指数显著降低。在大多数患者中，松开阻断后心指数仍低于正常水平（P<0.05）。有2例围手术期死亡，均死于心肌梗死或心力衰竭。这2例患者的射血分数均低于30%，初始心指数均低于2L/M²，而存活者的平均射血分数为63%±1，平均心指数为3.2L/M²±0.6。我们得出结论，术前评估射血分数可以筛选出腹主动脉手术中心脏死亡风险高的患者。这些患者应接受强化术前监测并改善心室功能。
