CAJ | 학술논문

目的通过动脉压力波或脉搏血氧饱和度波形估测肺小动脉楔压(PAWP).方法 14例择期腹部肿瘤手术的成年患者于全麻气管插管后,行术前急性高容量血液稀释,在输入10 ml/kg液体、20 ml/kg液体和关腹时,分别记录PAWP、动脉收缩压变化(systolic pressure variation, SPV)、动脉压力波形dDiwn(delta down)、脉氧波的SPVplet、dDownplet以及其他血液动力学参数,并记录应用Valsalva手法(气道压力30 cm H2O维持10 s)时最后一次心跳的收缩压与手法前呼吸暂停时的收缩压比值(arterial pressure ration, APR).结果 APR、SPV、dDown、SPVplet和dDownplet与PAWP的相关系数分别为0.717、-0.695、0.680、-0.522和-0.624(P均小于0.01),呈显著相关.其中APR与PAWP的相关性更好,回归方程为PAWP(mm Hg)=0.207×APR(%)-0.382.结论在正压通气条件下,APR、SPV、dDown、SPVplet和dDownplet均能有效地估测PAWP.
목적통과동맥압력파혹맥박혈양포화도파형고측폐소동맥설압(PAWP).방법 14례택기복부종류수술적성년환자우전마기관삽관후,행술전급성고용량혈액희석,재수입10 ml/kg액체、20 ml/kg액체화관복시,분별기록PAWP、동맥수축압변화(systolic pressure variation, SPV)、동맥압력파형dDiwn(delta down)、맥양파적SPVplet、dDownplet이급기타혈액동역학삼수,병기록응용Valsalva수법(기도압력30 cm H2O유지10 s)시최후일차심도적수축압여수법전호흡잠정시적수축압비치(arterial pressure ration, APR).결과 APR、SPV、dDown、SPVplet화dDownplet여PAWP적상관계수분별위0.717、-0.695、0.680、-0.522화-0.624(P균소우0.01),정현저상관.기중APR여PAWP적상관성경호,회귀방정위PAWP(mm Hg)=0.207×APR(%)-0.382.결론재정압통기조건하,APR、SPV、dDown、SPVplet화dDownplet균능유효지고측PAWP.
Objective To assess the possibility of using arterial pressure waveform or pulse oximetry plethysmographic waveform variation to estimate the pulmonary arterial wedge pressure (PAWP).Methods Fourteen American Society of Anesthesiologists grade Ⅰ-Ⅱ patients aged 33-69 years and weighing 62.0±9.5 kg scheduled for elective abdominal tumor surgery were studied. Their hemoglobin exceeded 120 g/L and hematocrit exceeded 35%. Pre-operative acute hypervolemic hemodilution was applied immediately after general anesthestic induction and tracheal intubation. PAWP, systolic pressure variation (SPV), delta down (dDown), SPVplet, dDownplet and other hemodynamic parameters were measured and recorded when total fluid volume (crystalloid and colloid) infused reached 10 ml/kg and 20 ml/kg and again at the end of the operation. Central venous pressure was maintained at 10-12 mm Hg during operation. Systolic blood pressure at the end of Valsalva maneuver (airway pressure was kept at 22 mm Hg) and the systolic pressure before the Valsalva manoeuvre during apnea were used to calculate arterial pressure ratio (APR). Results APR, SPV, dDown, SPVplet and dDownplet all correlated well with PAWP (r=0.717, -0.695, -0.680, -0.522 and -0.624 respectively, P<0.01). There was a closer linear correlation between APR and PAWP than between the other parameters. The regression equation was PAWP (mm Hg)=0.207×APR (%)-0.382. Conclusion During positive pressure mechanical ventilation, APR, SPV, dDown, SPVplet and dDownplet can be used to estimate PAWP effectively.