Rasmus Carter-Storch, Søren Mose Hansen, Jordi S Dahl, Kasper Enevold, Nils Sofus Borg Mogensen, Henrik Berg, Marie-Annick Clavel, Jacob E Møller
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引用次数: 1
Abstract
Introduction. Patients with severe aortic stenosis (AS) undergoing surgery are at increased risk of hypotension and hypoperfusion. Although treatable with inotropic agents or fluid, little is known about how these therapies affect central hemodynamics in AS patients under general anesthesia. We measured changes in central hemodynamics after dobutamine infusion and fluid bolus among patients with severe AS and associated these changes with preoperative echocardiography. Methods. We included 33 patients with severe AS undergoing surgical AVR. After induction of general anesthesia, hemodynamic measurements were obtained with a pulmonary artery catheter, including Cardiac index (CI), stroke volume index (SVi) and pulmonary capillary wedge pressure (PCWP). Measurements were repeated during dobutamine infusion, after fluid bolus and lastly after sternotomy. Results. General anesthesia resulted in a decrease in CI and SVi compared to preoperative values. During dobutamine infusion CI increased but mean SVi did not (38 ± 12 vs 37 ± 13 ml/m2, p = .90). Higher EF and SVi before surgery and a larger decrease in SVi after induction of general anesthesia were associated with an increase in SVi during dobutamine infusion. After fluid bolus both CI, SVi (48 ± 12 vs 37 ± 13 ml/min/m2, p < .0001) and PCWP increased. PCWP increased mostly among patients with a larger LA volume index. Conclusion. In patients with AS, CI can be increased with both dobutamine and fluid during surgery. Dobutamine's effect on SVI was highly variable and associated with baseline LVEF, and an increase in CI was mostly driven by an increase in heart rate. Fluid increased SVi at the cost of an increase in PCWP.
介绍。严重主动脉瓣狭窄(AS)患者接受手术时低血压和灌注不足的风险增加。虽然可以用肌力药物或液体治疗,但对于这些疗法如何影响全身麻醉下AS患者的中枢血流动力学知之甚少。我们测量了严重AS患者在多巴酚丁胺输注和输液后中枢血流动力学的变化,并将这些变化与术前超声心动图相关联。方法。我们纳入了33例接受外科AVR治疗的严重AS患者。全麻诱导后,通过肺动脉导管进行血流动力学测量,包括心脏指数(CI)、脑卒中容积指数(SVi)和肺毛细血管楔压(PCWP)。在多巴酚丁胺输注期间,在液体丸后和最后在胸骨切开后重复测量。结果。与术前相比,全身麻醉导致CI和SVi下降。多巴酚丁胺输注时CI升高,但平均SVi没有升高(38±12 vs 37±13 ml/m2, p = 0.90)。术前较高的EF和SVi以及全麻诱导后SVi的较大下降与多巴酚丁胺输注期间SVi的增加有关。注液后CI、SVi分别为48±12 vs 37±13 ml/min/m2, p。在AS患者中,术中多巴酚丁胺和液体均可增加CI。多巴酚丁胺对SVI的影响是高度可变的,与基线LVEF有关,CI的增加主要是由心率的增加引起的。流体增加SVi的代价是增加PCWP。
期刊介绍:
The principal aim of Scandinavian Cardiovascular Journal is to promote cardiovascular research that crosses the borders between disciplines. The journal is a forum for the entire field of cardiovascular research, basic and clinical including:
• Cardiology - Interventional and non-invasive
• Cardiovascular epidemiology
• Cardiovascular anaesthesia and intensive care
• Cardiovascular surgery
• Cardiovascular radiology
• Clinical physiology
• Transplantation of thoracic organs