NONINVASIVE DETERMINATION OF LEFT ATRIAL PRESSURE AND TOTAL VASCULAR RESISTANCE

左房压力是衡量患者容量状态的一种指标， 作为使用液体、利尿剂和血管加压药治疗的指南 充血性心力衰竭、休克和其他各种疾病的患者 血液动力学紊乱。左房压力的测量是常规的 侵入性的，通过经静脉置入肺动脉导管， 以肺动脉楔压作为左、右动脉的间接反映 心房压。这种侵入性测量技术需要相当大的 成本和一些潜在的发病率。 总血管阻力是衡量患者血管张力的指标， 用于帮助管理休克状态。通常情况下，它是由 同时获得心输出量(通过留置 热稀释肺动脉导管)和动脉压(来自 留置动脉内导管)。 横断面和多谱勒技术的研究进展 超声心动图使非心脏疾病的技术得以形成 有创性计算左房内压和总血管阻力。 然而，这些技术还没有在重症监护中得到验证。 单位患者人数。 在过去的一年里，我们在床边进行了超声心动图检查 为了验证这些技术，大约有40名患者。 如果这些技术被证明是可靠的，那么对侵入性技术的需求可能 会有显著的改善。此外，如果这些技术足够 准确地说，它们作为后续研究的调查工具是有希望的 在重症监护室进行液体、血管增压剂和血管扩张剂治疗 以及在门诊患者群体中。

Left atrial pressure is a measure of a patient's volume status, and serves as a guide to the use of fluid, diuretic, and vasopressor therapy in patients with congestive heart failure, shock, and various other hemodynamic derangements. Left atrial pressure conventionally is measured invasively, by transvenous placement of a pulmonary artery catheter, with the pulmonary artery wedge pressure taken as an indirect reflection of left atrial pressure. This invasive measurement technique entails considerable cost and some potential morbidity. Total vascular resistance is a measure of a patient's vascular tone, and is used to aid management of shock states. Ordinarily it is measured by obtaining simultaneously a cardiac output (from an indwelling thermodilution pulmonary artery catheter) and an arterial pressure (from an indwelling intra-arterial catheter). Advances in the state of the art of cross-sectional and Doppler echocardiography have permitted the formulation of techniques for non- invasive calculation of left atrial pressure and total vascular resistance. These techniques have not yet been validated, however, in a critical care unit patient population. In the past year, we have performed bedside echocardiography in approximately 40 patients for the purpose of validating these techniques. Should the techniques prove reliable, the need for invasive techniques may be ameliorated significantly. Further, if the techniques are sufficiently precise, they have promise as an investigative tool in subsequent studies of fluid, vasopressor, and vasodilator therapy both in critical care units and in ambulatory patient populations.