动脉压力波与脉搏血氧饱和度波形预测肺小动脉楔压的研究  

Prediction of pulmonary capillary wedge pressure from arterial pressure or pulse oximetry plethysmographic waveform

作　　者：许海芳[1] 周曙[1] 马伟[1] 于布为[1] 

机构地区：[1]上海第二医科大学附属瑞金医院麻醉科,200025

出　　处：《中华麻醉学杂志》2001年第10期614-616,共3页Chinese Journal of Anesthesiology

摘　　要：目的　通过动脉压力波或脉搏血氧饱和度波形估测肺小动脉楔压 (PAWP)。方法　 14例择期腹部肿瘤手术的成年患者于全麻气管插管后 ,行术前急性高容量血液稀释 ,在输入 10ml·kg-1液体、2 0ml·kg-1液体和关腹时 ,分别记录PAWP、动脉收缩压变化 (systolicpressurevariation ,SPV)、动脉压力波形dDown(deltadown)、脉氧波的SPVplet、dDownplet以及其他血液动力学参数 ,并记录应用Valsalva手法 (气道压力 30cmH2 O维持 10s)时最后一次心跳的收缩压与手法前呼吸暂停时的收缩压比值(arterialpressureratio,APR)。结果　APR、SPV、dDown、SPVplet和dDownplet与PAWP的相关系数分别为0 7174、- 0 6 95 1、- 0 6 80 1、- 0 5 2 16和 - 0 6 2 37(P均小于 0 0 1) ,呈显著相关。其中APR与PAWP的相关性更好 ,回归方程为PAWP(mmHg) =0 2 0 7×APR(% ) - 0 382。结论　在正压通气条件下 ,APR、SPV、dDown、SPVplet和dDownplet均能有效地估测PAWP。Objective To assess the possibility of using arterial pressure waveform or pulse oximetry plethysmographic waveform variation to estimate the pulmonary arterial wedge pressure (PAWP) Methods Fourteen ASA Ⅰ Ⅱ patients aged 33 69 years and weighing (62 0±9 5)kg scheduled for elective abdominal tumor surgery were studied Their Hb exceeded 120g/L and Hct 35% Anesthesia was induced with midazolam 0 04mg/kg atropine 8μg/kg,fentanyl 2μg/kg,propofol 2mg/kg and vecuronium 0 1mg/kg and maintained with isoflurane The patients were intubated and mechanically ventilated and P ET CO 2 was maintained at 4 67 5 33 kPa Radial artery was connulated for arterial pressure waveform monitoring and Swan Ganz catheter was inserted via right internal jugular vein and connected to continuous cardiac output monitor (VGS2,Baxter,USA) for hemodynamic monitoring Hypervolumic hemodilution was performed after induction of anesthesia and intubation with crystalloid and colloid (1:1) infused at a rate of 0 7ml·kg -1 ·min -1 PAWP, systolic pressure variation (SPV), delta down (dDown), SPV plet and dDown plet and other hemodynamic parameters were measured and recorded when total fluid volume (crystalloid and colloid) infused reached 10ml/kg and 20 ml/kg and at the end of operation, CVP was maintained at 10 12mm/kg during operation Systolic blood pressure at the end of Valsalva maneuver (airway pressure was kept at 30 cmH 2O) and the systolic pressure before the Valsalva maneuver during apnea were used to calculate arterial pressure ratio (APR) Results APR,SPV,dDown,SPV plet and dDown plet all correlated well with PAWP (r=o 7174,-0 6951,-0 680-0 5216 and 0 6237 respectively P<0 01) There was a closer linear correlation between APR and PAWP than between the other parameters The regression equation was PAWP (mmHg)=0 207×APR(%)-0 382 Conclusions During positive pressure mechanical ventilation APR,SPV,dDown,SPV plet ,and dDown plet can be used to estimate PA

关 键 词：血压测定 Valsalva手法 血氧测定法 肺楔压 麻醉学 

分 类 号：R614[医药卫生—麻醉学]