Cohen J L, Wender R, Maginot A, Cossman D, Treiman R, Foran R, Levin P, De Angelis J, Treiman G
Am J Surg. 1983 Aug;146(2):174-7. doi: 10.1016/0002-9610(83)90367-7.
Cardiac decompensation is clearly the major complication of aortic reconstructive surgery that leads to morbidity. Major changes in intravascular volume, third spacing, and increased systemic vascular resistance are extremely stressful to the diseased heart. Hemodynamic monitoring is readily available to provide an accurate evaluation of myocardial sensitivity and to allow for appropriate pharmacologic manipulation to preclude cardiac catastrophe. We believe all patients undergoing abdominal aortic reconstructive surgery should receive the benefit of pulmonary artery catheterization and intraarterial monitoring. The only requirement is a staff of surgeons, anesthesiologists, and nurses capable of correct interpretation of the data and use of drug therapy based on this information. The benefits are an accurate assessment of cardiac function with the ability to modulate the patient's hemodynamic values, preventing volume shifts, hypertensive and hypotensive crises, and abnormal fluctuations in preload and afterload, and ultimately a safer perioperative course.
心脏代偿失调显然是主动脉重建手术导致发病的主要并发症。血管内容量、第三间隙的重大变化以及全身血管阻力增加，对患病心脏造成极大压力。血流动力学监测可随时用于准确评估心肌敏感性，并允许进行适当的药物操作以预防心脏灾难。我们认为，所有接受腹主动脉重建手术的患者都应受益于肺动脉导管插入术和动脉内监测。唯一的要求是有一组能够正确解读数据并基于此信息使用药物治疗的外科医生、麻醉师和护士。其好处是能够准确评估心脏功能，并有能力调节患者的血流动力学值，防止容量转移、高血压和低血压危机以及前负荷和后负荷的异常波动，最终实现更安全的围手术期过程。
