Evaluation of left ventricular function in anesthetized patients using femoral artery dP/dtmax

被引:49
作者
De Hert, SG
Robert, D
Cromheecke, S
Michard, F
Nijs, J
Rodrigus, IE
机构
[1] Univ Antwerp Hosp, Dept Anesthesiol, B-2650 Edegem, Belgium
[2] Univ Antwerp Hosp, Dept Cardiac Surg, B-2650 Edegem, Belgium
[3] Univ Paris 11, Hop Marie Lannelongue, Dept Crit Care, Paris, France
关键词
coronary surgery; left ventricular function; dP/dt(max);
D O I
10.1053/j.jvca.2005.11.006
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Objective: The purpose of this study was to compare dP/dt(max) estimated from a femoral artery pressure tracing to left ventricular (LV) dP/dt(max) during various alterations in myocardial loading and contractile function. Participants: Seventy patients scheduled for elective coronary artery bypass surgery. Methods: All patients were instrumented with a high-fidelity LV catheter, a pulmonary artery catheter, and a femoral arterial catheter. In 40 patients, hemodynamic measurements were performed before and after passive leg raising and before and after calcium administration (5 mg/kg); and in 30 other patients, hemodynamic measurements were performed before and after dobutamine infusion (5 mu g/kg/min over 10 minutes). Results: LV and femoral dP/dt(max) were significantly correlated (r = 0.82, p < 0.001), but femoral dP/dt(max) systematically underestimated LV dP/dt(max) (bias = -361 +/- 96 mmHg/s). Passive leg raising induced significant increases in central venous pressure and LV end-diastolic pressure, but femoral dP/dt(max), stroke volume, and LV dP/dt(max) remained unaltered. Calcium administration induced significant and marked increases in LV dP/dt(max) (23% +/- 9%) and femoral dP/dt(max) (37% +/- 14%) associated with a significant increase in stroke volume (9% +/- 2%). Dobutamine infusion also induced significant and marked increases in LV dP/dt(max) (25% +/- 8%) and femoral dP/dt(max) (35% +/- 12%) associated with a significant increase in stroke volume (14% +/- 3%). Overall, a very close linear relationship (r = 0.93) and a good agreement (bias = -5 +/- 17 mmHg/s) were found between changes in LV dP/dt(max) and changes in femoral dP/dt(max). A very close relationship was also observed between changes in LV dP/dt(max) and changes in femoral dP/dt(max) during each intervention (leg raising, calcium administration, and dobutamine infusion). Conclusion: Femoral dP/dt(max) underestimated LV dP/dt(max)., but changes in femoral dP/dt(max) accurately reflected changes in LV dP/dt(max) during various interventions. (C) 2006 Elsevier Inc. All rights reserved.
引用
收藏
页码:325 / 330
页数:6
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