舒张末期容积与肺动脉楔压在评估创伤患者心脏前负荷中的应用

End-diastolic volume versus pulmonary artery wedge pressure in evaluating cardiac preload in trauma patients.

作者信息

Diebel L, Wilson R F, Heins J, Larky H, Warsow K, Wilson S

机构信息

Department of Surgery, Wayne State University, Detroit, MI 48201.

出版信息

J Trauma. 1994 Dec;37(6):950-5. doi: 10.1097/00005373-199412000-00014.

DOI:10.1097/00005373-199412000-00014

PMID:7996610

Abstract

OBJECTIVE

To evaluate the relative accuracy of right ventricular end-diastolic volume index (RVEDVI) and pulmonary artery wedge pressure (PAWP) for determining cardiac preload.

METHODS

A modified pulmonary artery catheter was used to determine RVEDVI, PAWP, and CI 238 times in 32 trauma patients.

RESULTS

The initial mean values included cardiac index (CI) = 3.4 +/- 1.3 L/min/m2, PAWP = 14.8 +/- 6.6 mm Hg, and RVEDVI = 99 +/- 40 mL/m2. Cardiac index correlated better with RVEDVI (r = 0.6440; p < 0.001) than with PAWP (r = 0.1068) or CVP (r = 0.1604). In 84 studies in 19 patients, the PAWP was high (19+ mm Hg) in spite of an RVEDVI that was low (< 90 mL/m2) in 22 (26%) or mid-range (90-140 mL/m2) in 49 (58%) of these. In addition, in 12 studies a high RVEDVI (> 140 mL/m2) existed with a relatively low PAWP (< 12 mm Hg). Thus, in 83 (35%) of the studies, PAWP provided information different from the RVEDVI. Of 65 instances in which preload was increased, CI "responded" (> or = 20%) in 26 (40%). The incidence of a response was not affected by the PAWP; however, responses with a RVEDVI of < 90, 90-140, or > 140 mL/m2 were 64%, 27%, and 0 (p < 0.001).

CONCLUSION

The RVEDVI more accurately predicted preload recruitable increases in CI than did the PAWP.

摘要

目的

评估右心室舒张末期容积指数（RVEDVI）和肺动脉楔压（PAWP）在确定心脏前负荷方面的相对准确性。

方法

使用改良的肺动脉导管对32例创伤患者进行了238次RVEDVI、PAWP和心脏指数（CI）的测定。

结果

初始平均值包括心脏指数（CI）=3.4±1.3L/（min·m²），PAWP=14.8±6.6mmHg，RVEDVI=99±40mL/m²。心脏指数与RVEDVI的相关性（r=0.6440；p<0.001）优于与PAWP（r=0.1068）或中心静脉压（CVP，r=0.1604）的相关性。在19例患者的84次研究中，尽管RVEDVI较低（<90mL/m²）的有22例（26%），中等范围（90-140mL/m²）的有49例（58%），但PAWP仍较高（>19mmHg）。此外，在12次研究中，RVEDVI较高（>140mL/m²）而PAWP相对较低（<12mmHg）。因此，在83次（35%）研究中，PAWP提供的信息与RVEDVI不同。在65例前负荷增加的情况中，CI“有反应”（≥20%）的有26例（40%）。反应发生率不受PAWP影响；然而，RVEDVI<90、90-140或>140mL/m²时的反应率分别为64%、27%和0（p<0.001）。