Chew M S, Sloth E, Veien M, Jensen K V, Kure H H, Hasenkam J M
Department of Anesthesia and Intensive Care, Aarhus University Hospital, Denmark.
Heart Vessels. 1996;11(5):269-74. doi: 10.1007/BF01746208.
Intraluminal movements of pulmonary artery catheters are seldom considered, although they may have a significant impact on flow measurement and safety. The purpose of this study was to document the movements of these catheters within the heart cycle, and to establish whether any patterns existed. We analyzed two-dimensional real time echocardiography cross-sectional images of the human pulmonary artery in 20 patients, plotting the position of the intra-arterial catheter frame-by-frame onto a standardized template. We found that movement of the catheter within the pulmonary artery occurred in a seemingly random pattern. There was no movement pattern to the inferior right of the vessel, an area known to have complex velocity profiles and erroneous velocity measurements. The catheter moved substantially throughout the heart cycle, occasionally quite close to the vessel wall. We observed significant movement of the pulmonary artery catheter throughout the heart cycle, without any predictable pattern. Although we did not specifically investigate the effect of these movements on cardiac output, they imply that intra-arterial Doppler flow measurements from the pulmonary artery may be inaccurate, since a stable catheter position, and hence, a sample volume, cannot be ensured. Further speculation can be made on the implications of these movements in regard to thermodilution cardiac output and safety.
肺动脉导管的管腔内移动很少被考虑，尽管它们可能对流量测量和安全性有重大影响。本研究的目的是记录这些导管在心动周期中的移动情况，并确定是否存在任何模式。我们分析了20例患者的人类肺动脉二维实时超声心动图横截面图像，逐帧将动脉内导管的位置绘制到标准化模板上。我们发现导管在肺动脉内的移动呈现出看似随机的模式。在血管右下方没有移动模式，该区域已知具有复杂的速度分布和错误的速度测量。导管在整个心动周期中大幅移动，偶尔非常靠近血管壁。我们观察到肺动脉导管在整个心动周期中都有显著移动，没有任何可预测的模式。虽然我们没有具体研究这些移动对心输出量的影响，但它们表明来自肺动脉的动脉内多普勒流量测量可能不准确，因为无法确保导管位置稳定，进而无法确保样本容积稳定。关于这些移动对热稀释法心输出量和安全性的影响，可以进一步进行推测。
