Transesophageal Echocardiography: An Objective Tool in Defining Maximum Ventricular Response to Intravenous Fluid Therapy
Transesophageal Echocardiography: An Objective Tool in Defining Maximum Ventricular Response to Intravenous Fluid Therapy
复制标题
经食管超声心动图：定义静脉输液治疗最大心室反应的客观工具
作者：
J. Swenson;C. Harkin;N. Pace;K. Astle;P. Bailey
心室前负荷是心功能的重要决定因素，临床上可通过肺毛细血管楔压（PCWP）间接测量，经食管超声心动图（TEE）作为心功能的监测手段正迅速得到人们的认可。虽然它提供了心脏结构的高分辨率图像，但使用TEE对心室前负荷的临床评估是主观的，因为难以及时进行定量测量。自动边界检测（ABD）是一种与TEE结合使用的新技术，可对腔面积进行定量实时二维测量。为了确定通过ABD测量的舒张末期面积（EDA）是否可用于确定静脉输液的适当终点，对9只杂种犬进行了研究。麻醉的动物被麻醉以达到0-5 mm Hg的中心静脉压。然后对每只动物静脉输注液体（自体血，然后输注羟乙基淀粉），直至达到热稀释心输出量（CO）峰值。每次液体推注后测量PCWP、EDA、CO和左心室每搏作功（LVSW）。显示给药体积与CO、LVSW和EDA的双变量图显示了这些变量中每一个的平行曲线，在累积体积为50-55 mL/kg时出现明显的峰。进行多元回归和混合模型协方差分析，以确定EDA与CO和LVSW变化的显著性。同样进行分析，比较PCWP与CO或LVSW变化之间的关系。当比较EDA与CO和LVSW的变化时，证明了显著的相关性（分别为P = 0.03和P < 0.0001）。比较PCWP与CO和LVSW变化的相似分析未能证明显著相关性（分别为P = 0.54和P = 0.36）。这些数据表明，使用TEE和ABD测量的EDA变化与心脏功能趋势相关，并可建议静脉输液的适当终点（由最大CO和LVSW定义）。PCWP与CO和LVSW的变化无显著相关性。（Anesth Analg 1996;83：1149- 1153）
Ventricular preload is an important determinant of cardiac function, which is indirectly measured in the clinical setting by the pulmonary capillary wedge pressure (PCWP).Transesophageal echocardiography (TEE) is rapidly gaining acceptance as a monitor of cardiac function. Although it provides high-resolution images of cardiac structures, clinical assessment of ventricular preload using TEE has been subjective, since quantitative measurements have been difficult to perform in a timely fashion. Automated border detection (ABD) is a new technology used in conjunction with TEE that allows quantitative real-time, two-dimensional measurement of cavity areas. To determine whether end-diastolic area (EDA) measured by ABD can be used to determine an appropriate end point for intravenous fluid administration, nine mongrel dogs were studied. Anesthetized animals were hemorrhaged to achieve a central venous pressure of 0-5 mm Hg. Each animal was then given intravenous fluid (autologous blood followed by hetastarch) until a peak in thermodilution cardiac output (CO) was achieved. Measures of PCWP, EDA, CO, and left ventricular stroke work (LVSW) were obtained after each fluid bolus. Bivariate plots displaying administered volume versus CO, LVSW, and EDA revealed parallel curves for each of these variables with peaks evident at cumulative volumes of 50-55 mL/kg. Multiple regression with mixed model analysis of covariance was performed to determine the significance of EDA in relation to changes in CO and LVSW. Analysis was likewise performed comparing the relationship between PCWP and changes in CO or LVSW. A significant relationship was demonstrated when comparing EDA to changes in CO and LVSW (P = 0.03 and P < 0.0001, respectively). Similar analysis comparing PCWP to changes in CO and LVSW failed to demonstrate a significant relationship (P = 0.54 and P = 0.36, respectively). These data suggest that changes in EDA measured using TEE with ABD are related to trends in cardiac function and can suggest an appropriate end point for intravenous fluid administration as defined by maximum CO and LVSW. PCWP did not demonstrate a significant relationship to changes in CO and LVSW. (Anesth Analg 1996;83:1149-53)
使用在线、半自动超声心动图边缘检测系统估计左心室腔面积。
影响因子：
37.8
作者：
Vandenberg,BF;Rath,LS;Stuhlmuller,P;MeltonJr,HE;Skorton,DJ
通讯作者：
Skorton,DJ
DOI：
10.1001/jama.268.2.210
发表时间：
1992
期刊：
JAMA
影响因子：
--
作者：
Eisenberg,MJ;London,MJ;Leung,JM;Browner,WS;Hollenberg,M;Tubau,JF;Tateo,IM;Schiller,NB;Mangano,DT
通讯作者：
Mangano,DT
DOI：
10.1016/0735-1097(92)90484-5
发表时间：
1992-02-01
影响因子：
24
作者：
PEREZ, JE;WAGGONER, AD;SOBEL, BE
通讯作者：
SOBEL, BE