Genesis of the characteristic pulmonary venous pressure waveform as described by the reservoir-wave model
Genesis of the characteristic pulmonary venous pressure waveform as described by the reservoir-wave model
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DOI：
10.1113/jphysiol.2014.272963
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发表时间：
2014-09-01
影响因子：
5.5
通讯作者：
Tyberg, John V.
中科院分区：
文献类型：
--
作者：
Bouwmeester, J. Christopher;Belenkie, Israel;Tyberg, John V.
传统的肺静脉和左房(LA)压力波形的血流动力学分析在整个心动周期中产生大量的前向和后向波；储藏波模型提供了一种在舒张期使用最小波的替代分析。测定麻醉犬单肺静脉(PV)和主肺动脉(PA)的压力和流量，观察低氧、一氧化氮、容量负荷和呼气末正压(PEEP)的影响。利用储集层波动模型确定了储集层对PV压力和流量的贡献。减去储集层压力和流量产生的超量被视为与波浪有关的量。超压和血流的波强度分析量化了起源于上游(来自PA)和下游(来自LA和/或左心室(LV))的波的贡献。特征性PV波形的主要特征是由顺序的LA和LV收缩和松弛引起的后向压缩(即增压)波，随后是减压(即降压)波。二尖瓣开口与反向减压波(即舒张期吸力)有关。在收缩末期和舒张期，起源于PA的前向波意义重大。这些波在容量负荷时衰减较小，在呼气末正压时延迟。储集层波动模型表明，在LV离散过程中，前向波和后向波可以忽略不计，上游储集层的流量可以解释压力和流量的变化。与此形成鲜明对比的是，传统的分析假设了前向波和后向波，即前向波的大部分能量与后向波相反。
Conventional haemodynamic analysis of pulmonary venous and left atrial (LA) pressure waveforms yields substantial forward and backward waves throughout the cardiac cycle; the reservoir wave model provides an alternative analysis with minimal waves during diastole. Pressure and flow in a single pulmonary vein (PV) and the main pulmonary artery (PA) were measured in anaesthetized dogs and the effects of hypoxia and nitric oxide, volume loading, and positive-end expiratory pressure (PEEP) were observed. The reservoir wave model was used to determine the reservoir contribution to PV pressure and flow. Subtracting reservoir pressure and flow resulted in excess' quantities which were treated as wave-related. Wave intensity analysis of excess pressure and flow quantified the contributions of waves originating upstream (from the PA) and downstream (from the LA and/or left ventricle (LV)). Major features of the characteristic PV waveform are caused by sequential LA and LV contraction and relaxation creating backward compression (i.e. pressure-increasing) waves followed by decompression (i.e. pressure-decreasing) waves. Mitral valve opening is linked to a backwards decompression wave (i.e. diastolic suction). During late systole and early diastole, forward waves originating in the PA are significant. These waves were attenuated less with volume loading and delayed with PEEP. The reservoir wave model shows that the forward and backward waves are negligible during LV diastasis and that the changes in pressure and flow can be accounted for by the discharge of upstream reservoirs. In sharp contrast, conventional analysis posits forward and backward waves such that much of the energy of the forward wave is opposed by the backward wave.