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首页> 外文期刊>American Journal of Physiology >Using velocity-pressure loops in the operating room: a new approach of arterial mechanics for cardiac afterload monitoring under general anesthesia.
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Using velocity-pressure loops in the operating room: a new approach of arterial mechanics for cardiac afterload monitoring under general anesthesia.

机译：手术室中使用速度压力环：全身麻醉下心脏后载监测动脉机械的新方法。

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Cardiac afterload is usually assessed in the ascending aorta and can be defined by the association of peripheral vascular resistance (PVR), total arterial compliance (Ctot), and aortic wave reflection (WR). We recently proposed the global afterload angle (GALA) and P-angle derived from the aortic velocity-pressure (VP) loop as continuous cardiac afterload monitoring in the descending thoracic aorta. The aim of this study was to 1) describe the arterial mechanic properties by studying the velocity-pressure relations according to cardiovascular risk (low-risk and high-risk patients) in the ascending and descending thoracic aorta and 2) analyze the association between the VP loop (GALA and p-angle) and cardiac afterload parameters (PVR, Ctot, and WR). PVR, Ctot, WR, and VP loop parameters were measured in the ascending and descending thoracic aorta in 50 anesthetized patients. At each aortic level, the mean arterial pressure (MAP), cardiac output (CO), and PVR were similar between low-risk and high-risk patients. In contrast, Ctot, WR, GALA, and p-angle were strongly influenced by cardiovascular risk factors regardless of the site of measurement along the aorta. The GALA angle was inversely related to aortic compliance, and the beta-angle reflected the magnitude of wave reflection in both the ascending and descending aortas (P < 0.001). Under general anesthesia, the VP loop can provide new visual insights into arterial mechanical properties compared with the traditional MAP and CO for the assessment of cardiac afterload. Further studies are necessary to demonstrate the clinical utility of the VP loop in the operating room. NEW & NOTEWORTHY Our team recently proposed the global afterload angle (GALA) and p-angle derived from the aortic velocity-pressure (VP) loop as continuous cardiac afterload monitoring in the descending thoracic aorta under general anesthesia. However, the evaluation of cardiac afterload at this location is unusual. The present study shows that VP loop parameters can describe the components of cardiac afterload both in the ascending and descending thoracic aorta in the operating room. Aging and cardiovascular risk factors strongly influence VP loop parameters. The VP loop could provide continuous visual additional information on the arterial system than the traditional mean arterial pressure and cardiac output during the general anesthesia.
机译：心脏后载通常在升高的主动脉中评估，并且可以通过外周血血管抗性（PVR），总动脉顺应性（CTOT）和主动脉波反射（WR）来定义。我们最近提出了从主动脉速度压力（vp）循环的全球后载角（GALA）和P角，作为下降胸主动脉中的连续心脏后载监测。本研究的目的是1）通过在上升和下降胸主动脉中的心血管风险（低风险和高风险患者）的速度压力关系和下降和下降胸主动脉和2）之间描述动脉机械性能。分析了VP环路（GALA和P角）和心脏后载参数（PVR，CTOT和WR）。在50名麻醉患者中，测量PVR，CTOT，WR和VP环路参数。在每个主动脉级，平均动脉压（MAP），心输出（CO）和PVR在低风险和高风险患者之间相似。相反，无论沿主动脉的测量部位如何，CTOT，WR，GALA和P角受到心血管危险因素的影响。 GALA角度与主动脉顺应性相反，并且β角反映了上升和下降主动脉中的波反射的大小（P <0.001）。在全身麻醉下，与传统地图和CO用于评估心脏后荷载相比，VP环路可以向动脉机械性能提供新的视觉洞察。进一步的研究是为了证明在手术室中VP环路的临床效用。新的和值得注意的我们的团队最近提出了从主动脉速度压力（VP）环导的全球后载角（GALA）和P角，作为一般麻醉下的下降胸主动脉中的连续心脏后载监测。然而，在这个位置的心脏后载评估是不寻常的。本研究表明，VP环路参数可以描述手术室中的上升和下降胸主动脉的心脏后载成分。老化和心血管危险因素强烈影响VP环路参数。 VP环路可以在通用麻醉期间的传统平均动脉压和心脏输出提供关于动脉系统的连续视觉附加信息。

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