Right ventricular function in human sepsis - A thermodilution study
Right ventricular function in human sepsis - A thermodilution study
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DOI：
10.1378/chest.112.4.1043
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发表时间：
1997-10-01
期刊：
影响因子：
9.6
通讯作者：
Brunet, F
中科院分区：
文献类型：
--
作者：
Dhainaut, JF;Pinsky, MR;Brunet, F
研究目的：评估脓毒症患者右心室（RV）压力和容量之间的关系。设计：前瞻性研究。设置：ICU。患者：18例血流动力学稳定的脓毒症患者。干预：通过军用抗休克裤（MAST）充气0、15、30，测量和结果：使用快速响应热敏电阻肺动脉导管基于RV射血分数（RVEF）计算来测量RV体积和压力。RV EDV以每搏输出量（SV）/RVEF估算，KV收缩末期容积（ESV）以EDV-SV估算。右心房压（Pra）作为舒张末期压，肺动脉压（Ppa），平均值和收缩末期，作为RV射血压。MAST充气至15 mm Hg对测量变量没有可测量的影响。然而，充气至30和50 mm Hg增加了Pra、平均和收缩末期Ppa、EDV和ESV，而SV和RVEF保持不变。不变Pra与EDV（r=0.33）或Pra与EDV、平均或收缩末期Ppa与ESV（r分别为0.5和0.28）之间的关系以及平均或收缩末期Ppa与ESV之间的关系均不好。此外，SV与EDV的相关性较差（r=0.32），而RVEF与EDV和ESV的相关性较好（分别为r=-0.41和-0.69），尽管它与平均或收缩末期Ppa没有明确的关系。然而，EDV的绝对和相对变化与各自的ESV值密切相关（r=0.93）。结论：在脓毒症期间，RV EDV和ESV的变化独立于Pra和射血压的变化。这些数据可以通过假设RV在填充期间是高度顺应性的腔室来解释，使得RV EDV的变化不会改变RV壁应力（预载荷）或射血效率（RVEF）。因此，RV EDV的变化应成比例地改变RV ESV。此外，ESV/EDV关系的斜率应与喷射效率成反比。
Study objective: To assess the relations among right ventricular (RV) pressures and volumes in sepsis.Design: Prospective study.Setting: ICU.Patients: Eighteen patients with sepsis who were in hemodynamically stable condition.Intervention: Stepwise increases and decreases in RV end-diastolic volume (EDV) as induced by military antishock trousers (MAST) inflation of 0, 15, 30, 50 and then 0 mm Hg over 15-min intervals.Measurements and results: RV volumes and pressures were measured using a rapid response thermistor pulmonary arterial catheter based on RV ejection fraction (RVEF) calculations. RV EDV was estimated as stroke volume (SV)/RVEF, while KV end-systolic volume (ESV) was estimated as EDV-SV. Right atrial pressure (Pra) was taken as end-diastolic pressure, and pulmonary artery pressures (Ppa), both mean and end-systolic, were used as RV ejection pressures. MAST inflation to 15 mm Hg had no measurable effects on the measured variables. However, inflation to 30 and 50 mm Hg increased Pra, both mean and end-systolic Ppa, EDV, and ESV, whereas SV and RVEF remained. unchanged. The relation between either Pra and EDV (r=0.33) or the change in Pra and EDV, mean or end-systolic Ppa and ESV (r=0.5 and 0.28, respectively), car the change in mean or end-systolic Ppa and ESV for both the group and individual subjects was poor. Furthermore, SV correlated poorly with EDV (r=0.32), while RVEF correlated better with both EDV and ESV (r=-0.41 and -0.69, respectively), although it showed no definable relation to mean or end-systolic Ppa. However, both absolute and relative changes in EDV corresponded closely with respective ESV values (r=0.93).Conclusions: During sepsis, RV EDV and ESV vary independently of changes in Pra and ejection pressure. These data can be explained by assuming that the RV is a highly compliant chamber during filling, such that changes in RV EDV do not alter RV wall stress (preload) or ejection efficiency (RVEF). Thus, changes in RV EDV should proportionally alter RV ESV. Furthermore, the slope of the ESV/EDV relation should be inversely proportional to ejection efficiency.