Mammana R B, Hiro S, Levitsky S, Thomas P A, Plachetka J
J Thorac Cardiovasc Surg. 1982 Sep;84(3):420-5.
Simultaneous measurements of pulmonary capillary wedge pressure (PCWP) and left atrial pressure (LAP) were obtained before and after cardiopulmonary bypass and for a period of 16 hours postoperatively in 20 consecutive patients undergoing electric cardiac operations. In contrast to several previous reports that PCWP accurately reflects left-sided hemodynamics, we found that the PCWP significantly exceeded the LAP in the early postbypass period and was most significantly in error at 4, 8, and 12 hours after operation (p less than .02) (95% confidence limit). The magnitude of this discrepancy differed in individual patients; however, it was consistent for each patient for the time period studied and independent of the procedure performed. The disparity between PCWP and LAP may be due to an increase in lung interstitial water as a result of hemodilution, or it may be related to the differing effects of afterload reducing agents on the pulmonary versus the systemic circulation. We conclude from these data that LAP more accurately reflects left ventricular filling and performance in the early postoperative period and should be used instead of PCWP to monitor the hemodynamics of postsurgical patients.
对20例连续接受心脏电手术的患者，在体外循环前后及术后16小时内同时测量肺毛细血管楔压（PCWP）和左心房压（LAP）。与之前一些报道称PCWP能准确反映左心血流动力学不同，我们发现，在体外循环后早期，PCWP显著超过LAP，且在术后4、8和12小时误差最为显著（p<0.02）（95%置信区间）。这种差异的程度在个体患者中有所不同；然而，在所研究的时间段内，每位患者的情况是一致的，且与所施行的手术无关。PCWP与LAP之间的差异可能是由于血液稀释导致肺间质水增加，或者可能与后负荷降低剂对肺循环和体循环的不同作用有关。从这些数据我们得出结论，在术后早期，LAP能更准确地反映左心室充盈和功能，应使用LAP而非PCWP来监测术后患者的血流动力学。
