Chait H I, Kuhn M A, Baum V C
Department of Anesthesiology, University of California at Los Angeles.
Crit Care Med. 1994 Feb;22(2):219-24. doi: 10.1097/00003246-199402000-00011.
To compare "central venous pressure" in pediatric patients in a clinical setting as measured from catheters in the infrahepatic inferior vena cava and the right atrium.
Prospective, unblinded study.
Cardiothoracic intensive care unit of a tertiary care university hospital.
Thirty-three pediatric cardiac surgical patients, 2 days to 92 months of age (mean 24 +/- 4 months).
All patients had intraoperative placement of an 8-cm, double-lumen, femoral venous catheter and a transthoracic right atrial catheter. Patients were studied for 0 to 2 days after surgery.
Measurements were obtained during mechanical and spontaneous ventilation. Although not statistically identical, measurements of "central" venous pressure in the inferior vena cava and right atrium correlated well (r2 = .87 for mechanical ventilation; r2 = .83 for spontaneous ventilation). Of 31 data pairs in mechanically ventilated patients, the absolute difference in pressures was as large as 3 mm Hg in three patients and <3 mm Hg in all the rest. In 15 spontaneously breathing patients, there were only three data measurements where the difference in pressure was 2 mm Hg and none of the differences was greater. In spontaneously breathing patients, the phasic changes due to respiratory variations in venous pressure were in phase in both the intrathoracic and intra-abdominal catheter positions.
We conclude that while "central" venous pressures measured in the inferior vena cava and in the right atrium are not statistically identical, any differences are well within clinically important limits. Placement of central venous pressure catheters in the inferior vena cava by the femoral venous approach is a reliable alternative to cannulating the superior vena cava in pediatric patients without clinically important intra-abdominal pathology and with anatomic continuity of the inferior vena cava with the right atrium. Relatively short femoral vein catheters allow adequate measurement of central venous pressure without concern for exact catheter tip position and without the risk of right atrial perforation, intracardiac arrhythmias, and inadvertent puncture of carotid and intrathoracic structures. Unlike previously reported results in neonates, we found that the phasic changes of venous pressure with the respiratory cycle were similar in both intrathoracic and intra-abdominal recordings, making this an inappropriate clinical indicator of venous catheter tip position.
比较在临床环境中，经肝下下腔静脉导管和右心房导管测量的儿科患者“中心静脉压”。
前瞻性、非盲法研究。
一所三级大学医院的心胸重症监护病房。
33例儿科心脏手术患者，年龄2天至92个月（平均24±4个月）。
所有患者术中均置入一根8厘米长的双腔股静脉导管和一根经胸右心房导管。术后对患者进行0至2天的研究。
在机械通气和自主呼吸时进行测量。虽然下腔静脉和右心房“中心”静脉压的测量值在统计学上并不完全相同，但两者相关性良好（机械通气时r2 = 0.87；自主呼吸时r2 = 0.83）。在机械通气患者的31对数据中，有3例患者的压力绝对差值高达3 mmHg，其余患者均<3 mmHg。在15例自主呼吸患者中，只有3次数据测量的压力差值为2 mmHg，且无差值更大的情况。在自主呼吸患者中，胸腔内和腹腔内导管位置的静脉压随呼吸变化的相位变化是同步的。
我们得出结论，虽然在下腔静脉和右心房测量的“中心”静脉压在统计学上并不相同，但任何差异都在临床重要范围内。对于无重要腹腔内病变且下腔静脉与右心房解剖连续的儿科患者，经股静脉途径在下腔静脉置入中心静脉压导管是一种可靠的替代上腔静脉插管的方法。相对较短的股静脉导管可充分测量中心静脉压，无需担心导管尖端的确切位置，也无右心房穿孔、心内心律失常以及意外穿刺颈动脉和胸内结构的风险。与先前报道的新生儿结果不同，我们发现胸腔内和腹腔内记录的静脉压随呼吸周期的相位变化相似，因此这不是判断静脉导管尖端位置的合适临床指标。
