VanBeck J O, White R D, Abenstein J P, Mullany C J, Orszulak T A
Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905.
J Cardiothorac Vasc Anesth. 1993 Jun;7(3):312-5. doi: 10.1016/1053-0770(93)90011-9.
Arterial pressure measured in a peripheral artery may significantly underestimate central arterial pressure after discontinuation of cardiopulmonary bypass (CPB). Arterial pressure measured with a 50 cm radial artery catheter advanced into the brachial or axillary artery was compared to ascending aortic pressure in 31 patients before and after discontinuation of CPB. The radial artery catheter extended proximally into the brachial artery in 8/31 patients, and into the axillary artery in 23/31 patients. The patient's age, pre-CPB cardiac ejection fraction, and surgical procedures were similar in both groups. The systolic arterial pressure measured in the ascending aorta was found to be significantly different from that in the axillary artery after CPB, whereas the mean and diastolic pressures were not. The average aorta-to-axillary artery systolic pressure gradient was -3.0 +/- 4.0 mmHg, with no patient having a gradient greater than 10 mmHg. The systolic and mean arterial pressures measured in the ascending aorta were found to be significantly different from that in the brachial artery after discontinuation of CPB, whereas the diastolic pressure was not. The average aorta-to-brachial artery systolic pressure gradient was 6.9 +/- 6.9 mmHg, with 3/8 patients having a gradient greater than 10 mmHg. Long radial artery catheters, placed using the Seldinger technique, provide an accurate estimate of central aortic pressure after CPB when they are advanced into the axillary artery. Sites more distal than the axillary artery may result in significant underestimation of the central aortic pressure in these patients.
在体外循环（CPB）停止后，在外周动脉测量的动脉压可能会显著低估中心动脉压。在31例患者CPB停止前后，将一根50 cm长的桡动脉导管推进至肱动脉或腋动脉所测量的动脉压与升主动脉压进行比较。在31例患者中，8例患者的桡动脉导管近端延伸至肱动脉，23例患者的桡动脉导管近端延伸至腋动脉。两组患者的年龄、CPB前心脏射血分数和手术操作相似。发现CPB后升主动脉测量的收缩压与腋动脉测量的收缩压有显著差异，而平均压和舒张压无显著差异。主动脉至腋动脉的平均收缩压梯度为-3.0±4.0 mmHg，没有患者的梯度大于10 mmHg。发现CPB停止后升主动脉测量的收缩压和平均动脉压与肱动脉测量的收缩压和平均动脉压有显著差异，而舒张压无显著差异。主动脉至肱动脉的平均收缩压梯度为6.9±6.9 mmHg，8例患者中有3例的梯度大于10 mmHg。使用Seldinger技术放置的长桡动脉导管，当推进至腋动脉时，可在CPB后提供对中心主动脉压的准确估计。比腋动脉更远端的部位可能会导致这些患者的中心主动脉压被显著低估。
