在Fontan循环中的正压通风过程中改变潮体积的血液动力学影响:一个随机交叉试验
Manchula Navaratnam1, Alexander R Schmidt2, Michelle Kaplinski3
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Children's Hospital, Stanford University Medical Center, Palo Alto, California, USA.
在Fontan患者的低潮量 (VT) 通风显著降低了气道压力,而不会改变血液动力学. 这项试点研究表明,谨慎的呼吸机管理是Fontan循环的关键,影响肺血流和心脏输出.
科学领域:
- 心脏病学 心脏病学
- 儿科心脏手术 儿科心脏手术
- 麻醉学 麻醉学
背景情况:
- 在Fontan循环中的肺血流取决于跨肺梯度和肺血管阻力 (PVR).
- 呼吸过程中的胸内压力变化会影响Fontan患者的血液动力学.
- 研究最佳通风策略对于管理Fontan循环至关重要.
研究的目的:
- 为了评估低 (5毫升/公斤) 与高 (10毫升/公斤) 的潮体积 (VT) 通风对Fontan循环血液动力学的影响.
- 在不同的通风设置下评估跨肺梯度,肺血流和心脏输出量的变化.
主要方法:
- 一个随机交叉试验,涉及手术后的Fontan循环患者.
- 患者进行了连续通风,使用不同的潮体积 (5,7和10毫升/公斤).
- 记录了血液动力学和食管横断性心声学 (TEE) 的测量结果.
主要成果:
- 与高VT (10mL/kg) 相比,低VT通风 (5mL/kg) 导致高VT (10mL/kg) 的峰值和平均气道压力明显降低.
- 没有观察到跨肺梯度,平均Fontan压力或TEE衍生的肺血流,中风体积或Fontan流量的显著差异.
- 在低和高VT组之间,最高吸气压,平均气道压力和吸气时间显著不同.
结论:
- 在Fontan患者的低潮通风有效降低了气道压力.
- 在低潮水量的情况下,风扇管理不会显著改变Fontan循环中的关键血液动力学参数.
- 这项试点研究突出了优化Fontan患者通风策略的潜力.
更多相关视频
07:09Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise
Published on: February 20, 2017
08:08Increasing Pulmonary Artery Pulsatile Flow Improves Hypoxic Pulmonary Hypertension in Piglets
Published on: May 11, 2015
相关概念视频
Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
Mechanical Ventilation I: Indication and Settings
Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
Factors Affecting Pulmonary Ventilation
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
Pressure Relationships in Thoracic Cavity
Breathing Mechanisms
Both intra-alveolar and intrapleural pressures rely on specific lung properties. The ability to breathe—allowing air to enter the lungs...
Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
