Slutsky R A, Dittrich H, Peck W W
Crit Care Med. 1983 Dec;11(12):913-7. doi: 10.1097/00003246-198312000-00001.
We evaluated the effects of deep inspiration, expiration, and the Valsalva maneuver on composite cardiac (left and right ventricular) and pulmonary volumes using equilibrium radionuclide angiography in 15 adult males without left or right ventricular dysfunction. The additional effects of nitroglycerin during these maneuvers were also examined. Midexpiration was used as the control point and data analyzed as a ratio (e.g., inspiration counts divided by midexpiration counts). Left ventricular volume (LVV) declined with inspiration (0.90 +/- 0.08 inspiratory/midexpiration) and with the Valsalva maneuver (0.89 +/- 0.08 Valsalva/midexpiration). Similar changes occurred after nitroglycerin, although the effects of the Valsalva maneuver on LVV were exaggerated when compared to the initial control intervention (0.79 +/- 0.09, vs 0.88 +/- 0.07, p less than .05). Right ventricular volume (RVV) increased with inspiration and decreased with the Valsalva maneuver; these changes were similar after nitroglycerin. Pulmonary blood volume (PBV) was greater with inspiration than expiration (1.02 +/- 0.10 vs 0.95 +/- 0.05, p less than .05), and was reduced with the Valsalva maneuver. Nitroglycerin reduced significantly all volumes and the reduction was similar for each compartment when respiratory interventions were compared. We conclude that blood pool imaging can be used to characterize abrupt fluxes in central circulatory volumes. Blood pool imaging of the heart and lungs should be considered a technique for monitoring the distribution of blood volume during acute pharmacologic and physiologic alterations.
我们采用平衡放射性核素血管造影术，对15名无左、右心室功能障碍的成年男性，评估了深吸气、呼气以及瓦尔萨尔瓦动作对心脏（左、右心室）和肺复合容积的影响。同时还研究了在这些动作过程中硝酸甘油的额外作用。以呼气中期作为对照点，并将数据作为比率进行分析（例如，吸气计数除以呼气中期计数）。左心室容积（LVV）在吸气时下降（吸气/呼气中期为0.90±0.08），在瓦尔萨尔瓦动作时下降（瓦尔萨尔瓦动作/呼气中期为0.89±0.08）。硝酸甘油使用后也出现了类似变化，不过与初始对照干预相比，瓦尔萨尔瓦动作对LVV的影响被放大了（0.79±0.09，对比0.88±0.07，p小于0.05）。右心室容积（RVV）在吸气时增加，在瓦尔萨尔瓦动作时减少；硝酸甘油使用后这些变化相似。肺血容量（PBV）吸气时大于呼气时（1.02±0.10对比0.95±0.05，p小于0.05），在瓦尔萨尔瓦动作时减少。硝酸甘油显著降低了所有容积，当比较呼吸干预时，每个腔室的降低情况相似。我们得出结论，血池成像可用于表征中心循环容积的突然变化。心肺血池成像应被视为一种在急性药理和生理改变期间监测血容量分布的技术。
