在高潮和低潮量策略之间比较Fontan生理学患者的心脏输出差异:一个随机交叉试验
P S Adams1, L M Stollings1, S Bains1
1UPMC Department of Anesthesiology and Perioperative Medicine, Division of Pediatric Cardiac Anesthesiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
对于接受机械通风的单心室心脏病患者,较低的潮体积可能更好地维持心脏输出. 这项研究发现没有显著差异,但趋势表明较低的体积是有利的.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
背景情况:
- 患者单心室先天性心脏病 (CHD) 缓解到Fontan生理缺乏一个本地心室的肺血流.
- 与负压通风相比,正压机械通风可以降低这些患者的心脏输出.
- 在Fontan患者中,机械通风的最佳潮体积设置仍然存在争议.
研究的目的:
- 为了确定更高或更低的潮体积是否对儿科Fontan患者的全身心脏输出是最佳的.
- 为了在不同的潮体积策略下比较全身心脏指数 (CI),肺血流和血管阻力.
主要方法:
- 一项涉及儿科Fontan患者 (18岁以下) 的交叉试验,在心脏导管治疗期间需要机械通风.
- 患者被随机分配到最初的高 (10毫升/千克) 或低 (6毫升/千克) 潮体积通风策略.
- 在通风策略之间比较了系统性CI,肺血流和血管阻力.
主要成果:
- 30名患者完成了这项研究. 较高的心脏指数在较低的潮体积策略中观察到更多的患者 (42%),而不是高潮体积策略 (33%).
- 在低 (3.19 L/min/m2) 和高 (2.96 L/min/m2) 潮体积策略之间,没有发现平均心脏指数的统计学上显著差异 (p=0.062).
- 该研究的动力是检测0.7L/分钟/m2.2的临床显著差异.
结论:
- 直接比较显示,在Fontan患者的高潮和低潮量策略之间,心脏指数没有显著差异.
- 数据表明,低潮量通风可能有利于维持一些需要正压通风的Fontan患者的心脏指数.
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