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

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(英文)

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,上海200025

出　　处：《Chinese Medical Journal》2002年第9期1372-1375,共4页中华医学杂志（英文版）

摘　　要：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 American Society of Anesthesiologists grade Ⅰ-Ⅱ patients aged 33-69 years and weighing 62 0±9 5 kg scheduled for elective abdominal tumor surgery were studied Their hemoglobin exceeded 120 g/L and hematocrit exceeded 35% Pre operative acute hypervolemic hemodilution was applied immediately after general anesthestic induction and tracheal intubation PAWP, systolic pressure variation (SPV), delta down (dDown), SPV plet , dDown plet and other hemodynamic parameters were measured and recorded when total fluid volume (crystalloid and colloid) infused reached 10 ml/kg and 20 ml/kg and again at the end of the operation Central venous pressure was maintained at 10-12 mm Hg during operation Systolic blood pressure at the end of Valsalva maneuver (airway pressure was kept at 22 mm Hg) and the systolic pressure before the Valsalva manoeuvre 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 =0 717, -0 695, -0 680, -0 522 and -0 624 respectively, P <0 01) There was a closer linear correlation between APR and PAWP than between the other parameters The regression equation was PAWP (mm Hg)=0 207×APR (%)-0 382 Conclusion During positive pressure mechanical ventilation, APR, SPV, dDown, SPV plet and dDown plet can be used to estimate PAWP effectively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液体、2 0ml/kg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dDiwn(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 (arterialpressureration ,APR)。结果　APR、SPV、dDown、SPVplet和dDownplet与PAWP的相关系数分别为 0 717、- 0 6 95、0 6 80、- 0 5 2 2和 - 0 6 2 4(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。

关 键 词：blood pressure determination  ·  Valsalva's maneuvre  ·  oximetry  ·   pulmonary wedge pressure 

分 类 号：R614[医药卫生—麻醉学]