Samuelsson S, Ehrenberg J, Settergren G
Department of Cardiothoracic Anaesthetics, Karolinska Hospital, Stockholm, Sweden.
J Cardiothorac Vasc Anesth. 1995 Dec;9(6):670-5. doi: 10.1016/s1053-0770(05)80228-9.
A clinical measure--inspection of the relation of the heart (acute margin) to the diaphragm--has shown a strong positive correlation to transesophageal echocardiographic (TEE) determination of left ventricular end-diastolic area (LVEDA) during weaning from cardiopulmonary bypass (CPB). The present study examines the correlation between right ventricular end-diastolic volumes (RVEDV) before and after CPB when using the same clinical measure of left ventricular dimension.
Prospective study.
Operating room, university hospital.
Patients scheduled for elective coronary artery bypass grafting.
After induction of anesthesia and endotracheal intubation, a transesophageal echo-probe was inserted. A pulmonary artery right ventricular ejection fraction/volumetric TD catheter was placed in the pulmonary artery.
Before going on CPB, a mark was made with cautery at the line of contact between the acute margin and the diaphragm. After CPB, the patients were transfused to the same level. At these two times, TEE recordings of the LVEDA and hemodynamic measurements including calculations of RVEDV were obtained. The LVEDA before and after CPB showed a positive correlation, r = 0.81, p < 0.001. The RVEDV after CPB showed a weak correlation, r = 0.54, p < 0.05, to RVEDV before CPB. There were no significant changes in right ventricular (RV) wall tension calculated as right atrial pressure x RVEDV and pulmonary artery systolic pressure x right ventricular end-systolic volume products. The only significant change regarding hemodynamic parameters was a decrease in mean arterial pressure.
It is concluded that there is only a weak correlation regarding RVEDV before and after CPB when the patient is transfused to the line of contact, whereas this clinical measure correlates well with LVEDA.
一项临床测量方法——检查心脏（急性边缘）与膈肌的关系——已显示出与在体外循环（CPB）撤机期间经食管超声心动图（TEE）测定左心室舒张末期面积（LVEDA）呈强正相关。本研究使用相同的左心室尺寸临床测量方法，检验CPB前后右心室舒张末期容积（RVEDV）之间的相关性。
前瞻性研究。
大学医院手术室。
择期冠状动脉搭桥手术患者。
麻醉诱导和气管插管后，插入经食管超声探头。将肺动脉右心室射血分数/容积TD导管置于肺动脉内。
在进行CPB之前，在急性边缘与膈肌的接触线上用电灼做标记。CPB后，将患者输血至相同水平。在这两个时间点，获取LVEDA的TEE记录以及包括RVEDV计算在内的血流动力学测量结果。CPB前后的LVEDA呈正相关，r = 0.81，p < 0.001。CPB后的RVEDV与CPB前的RVEDV呈弱相关，r = 0.54，p < 0.05。以右心房压力×RVEDV和肺动脉收缩压×右心室收缩末期容积乘积计算的右心室（RV）壁张力无显著变化。关于血流动力学参数的唯一显著变化是平均动脉压降低。
得出结论，当患者输血至接触线时，CPB前后的RVEDV仅呈弱相关，而该临床测量方法与LVEDA相关性良好。
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