Relationship of regional wall motion abnormalities to hemodynamic indices of myocardial oxygen supply and demand in patients undergoing CABG surgery.
Relationship of regional wall motion abnormalities to hemodynamic indices of myocardial oxygen supply and demand in patients undergoing CABG surgery.
复制标题
接受CABG手术的患者局部室壁运动异常与心肌氧供需血流动力学指标的关系。
DOI：
10.1097/00000542-199011000-00002
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发表时间：
1990
期刊：
影响因子：
8.8
通讯作者：
Mangano,DT
中科院分区：
文献类型：
--
作者：
Leung,JM;O'Kelly,BF;Mangano,DT
为了探讨围手术期局部壁运动异常（RWMA）的血流动力学相关性，我们通过经食管超声心动图（TEE）连续测量壁运动，并将RWMA与连续测量的心肌氧供需（心率[HR]、全身和肺动脉血压）血流动力学指标联系起来。对50例接受冠状动脉旁路移植术（CABG）的患者进行了术前、术后和重症监护病房（ICU）期间的研究。只有28%的TEE发作（RWMA提示缺血）之前有任何血流动力学参数的急性改变。具体来说，7%的TEE发作前有HR升高（与对照组有20%的偏差），14%有收缩压升高（SBP）， 13%有舒张压降低（DBP）， 9%有肺动脉舒张压升高（PAD）。12%的TEE发作与心率压积（RPP）增加到12000以上有关，27%的TEE发作时平均动脉压(MAP)/HR降低到小于1。不同时期的比较显示，与搭桥前相比，搭桥后TEE发作更频繁地与需求增加或供应减少相关（53% vs. 25%, P < 0.05）。ECG缺血性发作也很少（30%）与HR、收缩压、舒张压或PAD的急性变化相关。我们得出结论，围手术期TEE发作很少由血流动力学的变化触发，这表明心肌氧供应的原发性减少可能是大多数围手术期RWMA的重要机制。此外，肺动脉导管压力测量和专门指标（RPP和MAP/HR）似乎都不能用于预测TEE发作。
To investigate the hemodynamic correlates of perioperative regional wall motion abnormalities (RWMA), we measured wall motion continuously via transesophageal echocardiography (TEE), and related RWMA to continuously measured hemodynamic indices of myocardial oxygen supply and demand (heart rate [HR] and systemic and pulmonary arterial blood pressures). Fifty patients undergoing coronary artery bypass graft (CABG) surgery were studied throughout the prebypass postbypass, and intensive care unit (ICU) periods. Only 28% of TEE episodes (RWMA suggestive of ischemia) were preceded by acute changes in any hemodynamic parameter. Specifically, 7% of TEE episodes were preceded by increases in HR (20% deviation from control), 14% by increases in systolic blood pressure (SBP), 13% by decreases in diastolic blood pressure (DBP), and 9% by increases in pulmonary artery diastolic pressure (PAD). Twelve per cent of TEE episodes were associated with increases in rate-pressure product (RPP) to greater than 12,000, and 27% were associated with decreases in mean arterial pressure (MAP)/HR to less than 1 at the onset of TEE episodes. Comparison among periods revealed that postbypass TEE episodes were more frequently associated with either increases in demand or decreases in supply than were prebypass episodes (53% vs. 25%, P less than 0.05). ECG ischemic episodes also were infrequently (30%) associated with acute changes in HR, SBP, DBP, or PAD. We conclude that perioperative TEE episodes are infrequently triggered by changes in hemodynamics, suggesting that a primary decrease in myocardial oxygen supply may be an important mechanism for most perioperative RWMA. In addition, neither pulmonary artery catheter pressure measurements nor specialized indices (RPP and MAP/HR) appear to be useful in predicting TEE episodes.