冠状动脉搭桥手术患者的收缩末期压力-容积关系与心室动脉耦联

The end-systolic pressure-volume relationship and ventriculoarterial coupling in patients undergoing coronary artery bypass graft surgery.

作者信息

Kadoi Y, Kawahara H, Fujita N

机构信息

Department of Anesthesiology and Reanimatology, Gunma University, School of Medicine, Japan.

出版信息

Acta Anaesthesiol Scand. 1998 Mar;42(3):369-75. doi: 10.1111/j.1399-6576.1998.tb04931.x.

DOI:10.1111/j.1399-6576.1998.tb04931.x

PMID:9542567

Abstract

BACKGROUND

The end-systolic pressure-volume relationship and analysis of ventriculoarterial coupling have been established as a useful tool to determine the left ventricular performance and arterial loading conditions. The purpose of this study was to evaluate the end-systolic pressure-volume relationship and ventriculoarterial coupling in anesthetized patients with either a normal heart or coronary artery disease (CAD) using a transesophageal echocardiography (TEE) monitor.

METHODS

Sixteen patients with CAD and 4 patients without ischemic disease were studied. The end-systolic volume of the left ventricle was obtained by TEE, and the end-systolic pressure was obtained from the brachial arterial dicrotic pressure. In order to obtain the end-systolic pressure-volume relationship, we plotted 7 different left ventricular end-systolic pressures against the corresponding left ventricular end-systolic volumes during the pressure manipulation. The linear regression obtained by this method was designated as the end-systolic elastance (Ees). Furthermore, we calculated the effective arterial elastance (Ea) using the pressure-volume framework.

RESULTS

We divided the patients with CAD into 3 groups: Group A: left ventricular ejection fraction (LVEF) > 50%, Group B: LVEF 35-50%, Group C: LVEF < 35%. We also studied a control group (Group D) who did not suffer from an ischemic heart condition. Ees in group C (1.4 +/- 0.2) was lower than in the other 3 groups (P < 0.05). Ea/Ees in group C (1.9 +/- 0.1) was greater than in group A (0.7 +/- 0.1), group B (1.0 +/- 0.06) and group D (0.6 +/- 0.1)(P < 0.05). There were no significant differences in Ees and Ea/Ees between group A and group D.

CONCLUSIONS

We found that patients with CAD and a normal LVEF had a physiological Ea/Ees identical to the control subjects. We also demonstrated that patients with CAD and a reduced LVEF showed a deterioration in Ea/Ees.

摘要

背景

收缩末期压力-容积关系以及心室动脉耦联分析已成为确定左心室功能和动脉负荷状况的有用工具。本研究的目的是使用经食管超声心动图（TEE）监测仪评估正常心脏或冠心病（CAD）的麻醉患者的收缩末期压力-容积关系和心室动脉耦联。

方法

研究了16例CAD患者和4例无缺血性疾病的患者。通过TEE获得左心室的收缩末期容积，并从肱动脉重搏波压力获得收缩末期压力。为了获得收缩末期压力-容积关系，我们在压力操纵期间绘制了7种不同的左心室收缩末期压力与相应的左心室收缩末期容积的关系。通过该方法获得的线性回归被指定为收缩末期弹性（Ees）。此外，我们使用压力-容积框架计算有效动脉弹性（Ea）。

结果

我们将CAD患者分为3组：A组：左心室射血分数（LVEF）>50%，B组：LVEF 35-50%，C组：LVEF<35%。我们还研究了一个未患缺血性心脏病的对照组（D组）。C组的Ees（1.4±0.2）低于其他3组（P<0.05）。C组的Ea/Ees（1.9±0.1）高于A组（0.7±0.1）、B组（1.0±0.06）和D组（0.6±0.1）（P<0.05）。A组和D组之间的Ees和Ea/Ees无显著差异。