Effects of mid-line thoracotomy on the interaction between mechanical ventilation and cardiac filling during cardiac surgery
Effects of mid-line thoracotomy on the interaction between mechanical ventilation and cardiac filling during cardiac surgery
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DOI：
10.1093/bja/aeh151
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发表时间：
2004-06-01
影响因子：
9.8
通讯作者：
Goetz, AE
中科院分区：
文献类型：
--
作者：
Reuter, DA;Goresch, T;Goetz, AE
背景中线开胸术是心脏手术的标准方法。然而，很少有人知道这种手术方法如何影响循环和机械通气之间的相互作用。我们研究了中线开胸术如何影响心脏充盈量和心血管血流动力学，特别是机械通气引起的每搏输出量和脉压的变化。我们研究了19例择期冠状动脉搭桥手术的患者。采用热稀释法测定开胸前后动脉压、心脏指数（CI）、整体舒张末期容积指数（GEDVI），经食管超声心动图测定左室舒张末期面积指数（LVEDAI），动脉脉搏波形分析法测定通气时左室每搏量和脉压的变化。开胸术后，CI从2.3（0.4）升至2.9（0.6）升min（-1）m（-2），GEDVI从605（110）升至640（94）升min（-1）m（-2），LVEDAI从9.2（3.7）升至11.2（4.1）cm（2）m（-2）。所有这些变化都是重大的。相比之下，每搏输出量变异度（SVV）从10（3）%降至6（2）%，脉压变异度（PPV）从11（3）%降至5（3）%。开胸前SVV、PPV与GEDVI显著相关（均P
Background. Mid-line thoracotomy is a standard approach for cardiac surgery. However, little is known how this surgical approach affects the interaction between the circulation and mechanical ventilation. We studied how mid-line thoracotomy affects cardiac filling volumes and cardiovascular haemodynamics, particularly variations in stroke volume and pulse pressure caused by mechanical ventilation.Methods. We studied 19 patients during elective coronary artery bypass surgery. Before and after mid-line thoracotomy, we measured arterial pressure, cardiac index (CI) and global end-diastolic volume index (GEDVI) by thermodilution, left ventricular end-diastolic area index (LVEDAI) by transoesophageal echocardiography and the variations in left ventricular stroke volume and pulse pressure during ventilation by arterial pulse contour analysis.Results. After thoracotomy, CI increased from 2.3 (0.4) to 2.9 (0.6) litre min(-1) m(-2), GEDVI increased from 605 (110) to 640 (94) litre min(-1) m(-2), and LVEDAI increased from 9.2 (3.7) to 11.2 (4.1) cm(2) m(-2). All these changes were significant. In contrast, stroke volume variation (SVV) decreased from 10 (3) to 6 (2)% and pulse pressure variation (PPV) decreased from 11 (3) to 5 (3)%. Before thoracotomy, SVV and PPV significantly correlated with GEDVI (both P