一种在呼气末正压通气期间计算左心室跨壁充盈压的潜在临床方法：一项人体术中研究

A potential clinical method for calculating transmural left ventricular filling pressure during positive end-expiratory pressure ventilation: an intraoperative study in humans.

作者信息

Smiseth O A, Thompson C R, Ling H, Robinson M, Miyagishima R T

机构信息

Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.

出版信息

J Am Coll Cardiol. 1996 Jan;27(1):155-60. doi: 10.1016/0735-1097(95)00420-3.

DOI:10.1016/0735-1097(95)00420-3

PMID:8522690

Abstract

OBJECTIVES

This study sought to investigate whether right atrial pressure could be used to estimate pericardial pressure during positive end-expiratory pressure (PEEP).

BACKGROUND

Because of elevated intrathoracic pressure during PEEP, pulmonary capillary wedge pressure may not accurately reflect left ventricular preload. An estimate of pericardial pressure during PEEP would allow assessment of transmural filling pressure.

METHODS

In eight patients, at the start of cardiac surgery, pericardial and pleural pressures were recorded by balloon transducers placed over the anterolateral left ventricular wall. We also recorded intravascular pressures and left ventricular short-axis area by transesophageal echocardiography.

RESULTS

A stepwise increase in PEEP from 0 to 15 cm H2O caused a linear increase in pleural pressure from 0.3 +/- 0.6 (mean +/- SEM) to 6.1 +/- 0.8 mm Hg (p < 0.01). Pericardial pressure increased from 2.3 +/- 0.5 to 5.9 +/- 0.6 mm Hg (p < 0.01). The correlation between right atrial (Pra) and pericardial pressure (Pperic) was good: Pra = 0.85 x Pperic + 1.8, r = 0.77. The correlation between changes in right atrial pressure and in pericardial pressure was better: delta Pra = 0.96 x delta Pperic -0.2, r = 0.97. Pulmonary capillary wedge pressure increased with PEEP (p < 0.05), whereas left ventricular area decreased (p < 0.05). However, there was a progressive reduction in transmural pressure, calculated as wedge pressure minus pericardial pressure (p < 0.05), and in transmural pressure, estimated as wedge pressure minus right atrial pressure (p < 0.05). The estimated transmural filling pressure correlated (r = 0.86) with end-diastolic area.

CONCLUSIONS

The present observations suggest that right atrial pressure may be used to estimate changes in pericardial pressure with PEEP and that pulmonary capillary wedge pressure minus right atrial pressure is a potentially clinically useful approximation of transmural filling pressure.

摘要

目的

本研究旨在探讨在呼气末正压通气（PEEP）期间，右心房压力是否可用于估计心包压力。

背景

由于PEEP期间胸内压升高，肺毛细血管楔压可能无法准确反映左心室前负荷。估计PEEP期间的心包压力将有助于评估跨壁充盈压。

方法

在8例心脏手术患者中，于手术开始时，通过置于左心室前外侧壁上的球囊传感器记录心包和胸膜压力。我们还通过经食管超声心动图记录血管内压力和左心室短轴面积。

结果

PEEP从0逐步增加至15 cm H₂O时，胸膜压力从0.3±0.6（均值±标准误）线性增加至6.1±0.8 mmHg（p<0.01）。心包压力从2.3±0.5增加至5.9±0.6 mmHg（p<0.01）。右心房（Pra）与心包压力（Pperic）之间的相关性良好：Pra = 0.85×Pperic + 1.8，r = 0.77。右心房压力变化与心包压力变化之间的相关性更好：ΔPra = 0.96×ΔPperic - 0.2，r = 0.97。肺毛细血管楔压随PEEP升高（p<0.05），而左心室面积减小（p<0.05）。然而，计算为楔压减去心包压力的跨壁压力（p<0.05）以及估计为楔压减去右心房压力的跨壁压力均逐渐降低（p<0.05）。估计的跨壁充盈压与舒张末期面积相关（r = 0.86）。