Right atrial pressure and venous return during cardiopulmonary bypass
Right atrial pressure and venous return during cardiopulmonary bypass
复制标题
DOI：
10.1152/ajpheart.00081.2017
复制
发表时间：
2017-08-01
影响因子：
4.8
通讯作者：
Berger, David
中科院分区：
文献类型：
--
作者：
Moller, Per W.;Winkler, Bernhard;Berger, David
在循环动态变化过程中，右心房压（RAP）作为静脉回流背压（Q（VR））和平均体循环充盈压作为上游压的相关性存在争议。为了检查Q（VR）（腔静脉流量总和）对RAP和泵功能变化的即时反应，我们使用了一种闭胸、中心插管、心脏旁路猪制剂（n = 10），采用静脉动脉体外膜氧合。在血容量正常、容量扩张（9.75 ml/kg羟乙基淀粉）和血容量不足（容量扩张后出血19.5 ml/kg）时，通过夹持开放或闭合动静脉分流的体外膜氧合管路测定平均全身充盈压。在恒定气道压力（P-AW）下使用可变泵速和可变P-AW下使用恒定泵速研究RAP和Q（VR）的响应。在每种容量状态下，Q（VR）和RAP的即时变化可以用一个线性回归来描述，无论RAP是否被泵速或P-AW改变（r（2）= 0.586-0.984）。从零到最大流量，RAP与泵速成反比（r（2）= 0.8590.999）。改变P-AW可引起RAP和Q（VR）立即、短暂、方向相反的变化（RAP：P
The relevance of right atrial pressure (RAP) as the backpressure for venous return (Q(VR)) and mean systemic filling pressure as upstream pressure is controversial during dynamic changes of circulation. To examine the immediate response of Q(VR) (sum of caval vein flows) to changes in RAP and pump function, we used a closed-chest, central cannulation, heart bypass porcine preparation (n = 10) with venoarterial extracorporeal membrane oxygenation. Mean systemic filling pressure was determined by clamping extracorporeal membrane oxygenation tubing with open or closed arteriovenous shunt at euvolemia, volume expansion (9.75 ml/kg hydroxyethyl starch), and hypovolemia (bleeding 19.5 ml/kg after volume expansion). The responses of RAP and Q(VR) were studied using variable pump speed at constant airway pressure (P-AW) and constant pump speed at variable P-AW. Within each volume state, the immediate changes in Q(VR) and RAP could be described with a single linear regression, regardless of whether RAP was altered by pump speed or P-AW (r(2) = 0.586-0.984). RAP was inversely proportional to pump speed from zero to maximum flow (r(2) = 0.8590.999). Changing P-AW caused immediate, transient, directionally opposite changes in RAP and Q(VR) (RAP: P