NONINVASIVE DETERMINATION OF LEFT ATRIAL PRESSURE AND TOTAL VASCULAR RESISTANCE

左心房压力是患者容量状态的量度，并且用于 作为液体、利尿剂和血管加压药治疗的指南， 充血性心力衰竭、休克和各种其他 血流动力学紊乱 左心房压力常规测量 通过经静脉放置肺动脉导管， 肺动脉楔压作为左室舒张功能的间接反映， 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。 总血管阻力是患者血管张力的量度， 用于帮助管理休克状态。 通常，它是通过 同时获得心输出量（从留置 热稀释肺动脉导管）和来自动脉导管的动脉压。 留置动脉内导管）。 横断面和多普勒超声技术的进展 超声心动图已经允许制定技术， 有创计算左心房压力和总血管阻力。 然而，这些技术尚未在重症监护中得到验证。 单位患者人群。 在过去的两年里，我们在100例患者中进行了床旁超声心动图检查。 大约60名患者，以验证这些技术。 常规胸骨上多普勒测量心输出量 已经证明超声心动图在危重患者中无效， 采用改良心尖多普勒技术。 应 修改后的技术证明足够精确，他们有希望作为一个 在随后的流体研究中的调查工具，足够精确， 它们有希望作为后续流体研究中的研究工具， 血管加压药和血管扩张药治疗，无论是在重症监护病房和 门诊患者人群。

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 two years, we have performed bedside echocardiography in approximately 60 patients for the purpose of validating these techniques. the conventional measurement of cardiac output from suprasternal Doppler echocardiography has been proven to be invalid in critically ill patients, and a modified apical Doppler technique has been adopted. Should be modified techniques prove sufficiently precise, they have promise as an investigative tool in subsequent studies of fluid, sufficiently precise, they have promise as an investigative tool in subsequent studies of fluid, vasopressor, and vasodilator therapy both n critical care units and in ambulatory patient populations.