Prediction of pulmonary capillary wedge pressure from arterial pressure or pulse oximetry plethysmographic waveform / 中华麻醉学杂志

ABSTRACT

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 ASA Ⅰ Ⅱ patients aged 33 69 years and weighing (62 0?9 5)kg scheduled for elective abdominal tumor surgery were studied Their Hb exceeded 120g/L and Hct 35% Anesthesia was induced with midazolam 0 04mg/kg atropine 8?g/kg,fentanyl 2?g/kg,propofol 2mg/kg and vecuronium 0 1mg/kg and maintained with isoflurane The patients were intubated and mechanically ventilated and P ET CO 2 was maintained at 4 67 5 33 kPa Radial artery was connulated for arterial pressure waveform monitoring and Swan Ganz catheter was inserted via right internal jugular vein and connected to continuous cardiac output monitor (VGS2,Baxter,USA) for hemodynamic monitoring Hypervolumic hemodilution was performed after induction of anesthesia and intubation with crystalloid and colloid (11) infused at a rate of 0 7ml?kg -1 ?min -1 PAWP, systolic pressure variation (SPV), delta down (dDown), SPV plet and dDown plet and other hemodynamic parameters were measured and recorded when total fluid volume (crystalloid and colloid) infused reached 10ml/kg and 20 ml/kg and at the end of operation, CVP was maintained at 10 12mm/kg during operation Systolic blood pressure at the end of Valsalva maneuver (airway pressure was kept at 30 cmH 2O) and the systolic pressure before the Valsalva maneuver during apnea were used to calculate arterial pressure ratio (APR) Results APR,SPV,dDown,SPV plet and dDown plet all correlated well with PAWP (r=o 7174,-0 6951,-0 680-0 5216 and 0 6237 respectively P