右心室舒张末容积在心脏外科术后监测中的意义

目的探讨右心室舒张末容积指数（RVEDVI）在监测心脏外科术后患者心室前负荷中的意义。方法50例患者，男31例，女19例，年龄（68±11）（46～87）岁，接受冠状动脉搭桥术或瓣膜置换术。心脏外科术后用改良的Swan-Ganz漂浮导管接连续心排量监测仪监测心脏指数（CI）、肺毛细血管楔压（PCWP）、RVEDVI、右心室射血分数（RVEF）中心静脉压（CVP）及混合静脉血氧饱和度（SvO2），每1～2h观察一次。测量持续（64±25）h。用单因素线性回归分析这些数据间的相关性。结果RVEDVI的均数为（130±28）ml／m^2，CI的均数为（3．1±0．6）L/（min·m^2）、PCWP的均数为（11．4±4．1）mmHg。50例患者中约有26例REVDVI、25例CVP和CI之间有明显的正相关，有7例PCWP和CI存在明显的正相关；有10％的患者中，CVP和CI之间呈负相关，只有4％的患者，REVDVI和CI之间呈负相关。结论RVEDVI是心脏外科术后监测中有明显的意义。

Significance of right ventricular end-diastolic volume index in monitoring ventricular preload in patients after cardiac surgery

Objective To evaluate whether right ventricular end-diastolic volume index （RVEDVI）effectively reflects the ventricular preload in patients after cardiac surgery. Methods Fifty patients, 31 males and 19 females, aged （68 ± 11） （46-87）, underwent cardiac surgery, including coronary artery bypass grafting and cardiac valve replacement. After the cardiac surgery they underwent insertion of floating catheter linking to a continuous heart stroke monitoring meter to monitor the cardiac index （CI）, pulmonary capillary wedge pressure （PCWP）, central venous pressure （CVP）, right ventricular end-diastolic volume index （RVEDVI）, right ventricular ejection fraction （EVEF）, and mixed venous oxygen saturation （SvO2）, measured every 1-2 hours. The measurement lasted for （64 ± 25） hours Univariate linear regression was used to analyze the correlation among these data. Results The means of RVEDVI, CI, and PCWP were （130 ± 28） ml/m^2, （3.1 ± 0.6） L/min/m^2, and （11 ± 4） mmHg respectively. REVDVI was significantly positively correlated with CI in 26 of the 50 patients, CVP was significantly positively correlated with CI in 25 of the 50 patients, PWCP was significantly positively correlated with CI in 7 of the 50 patients （14%, r^2=0.212, P〈0.01）. In 5 of the 50 patients （10%） CVP was significantly negatively correlated with CI negative correlation with CI, whereas 4% showed a negative correlation between REVDVI and CI. Conc lus ion RVEDVI is a significant preload index during the postoperative management after cardiac surgery.