背景:在心脏手术期间,右心室流出道梗阻(RVOTO)定义为右心室收缩压(RVSP)和肺动脉收缩压(PASP)之间的瞬时压差≥6mmHg,时间≥5分钟。RVOTO的风险因素仍然知之甚少。这项队列研究旨在评估发病率,经历RVOTO的患者的特征和结果。
方法:在心脏手术期间,使用带右心室端口的肺动脉导管,从回顾性(n=295)和前瞻性(n=105)队列中测量RVSP和PASP之间的瞬时压差。
结果:从回顾性和前瞻性队列中,开始体外循环(CPB)前RVOTO的发生率分别为30.2和36.2%,CPB分离后为43.7和47.6%.CPB启动前,RVOTO患者的心输出量较高(4.2±1.5vs3.8±1.1L·min-1,P=0.033),接受了更多的吸入依前列醇(79%vs61%,P=0.005)和同向异构体(66vs51%,P=0.016)与没有RVOTO的那些相比。CPB分离后,RVOTO患者的心率更高(62±15vs58±13次搏动·min-1,P=0.011),心输出量(4.1±1.4vs3.7±1.1L·min-1,P=0.003),CPB持续时间(90±45vs77±30分钟,P=0.014),较低的液体平衡(758±1123vs1063±1089mL,P=0.021),并且更多暴露于气管内米力农(12vs4%,P=0.015)与没有RVOTO的那些相比。术后28天持续性器官功能障碍(TPOD)的时间在发生RVOTO事件的患者中相似,CPB开始前或CPB分离后,与那些没有的人相比。
结论:RVOTO在心脏手术中很常见。然而,它与更长的TPOD无关。
BACKGROUND: During cardiac surgery, right ventricular outflow tract obstruction (RVOTO) is defined as an instantaneous pressure difference ≥6 mmHg between right ventricular systolic pressure (RVSP) and pulmonary artery systolic pressure (PASP), for ≥5 minutes. Risk factors for RVOTO remain poorly understood. This cohort study is designed to evaluate the incidence, characteristics and outcomes of the patients who experienced RVOTO.
METHODS: Instantaneous pressure difference between RVSP and PASP was measured using a pulmonary artery catheter with a right ventricular port during cardiac surgery from a retrospective (n=295) and a prospective (n=105) cohort.
RESULTS: From the retrospective and prospective cohort, incidence of RVOTO was 30.2 and 36.2% before cardiopulmonary bypass (CPB) initiation and 43.7 and 47.6% after CPB separation. Before CPB initiation, patients with RVOTO had higher cardiac output (4.2±1.5 vs 3.8±1.1L⋅min-1, P=0.033), received more inhaled epoprostenol (79 vs 61%, P=0.005) and inotropes (66 vs 51%, P=0.016) compared to those without RVOTO. After CPB separation, patients with RVOTO had higher heart rate (62±15 vs 58±13 beats⋅min-1, P=0.011), cardiac output (4.1±1.4 vs 3.7±1.1L⋅min-1, P=0.003), CPB duration (90±45 vs 77±30mins, P=0.014), lower fluid balance (758±1123 vs 1063±1089mL, P=0.021) and were more exposed to intratracheal milrinone (12 vs 4%, P=0.015) compared to those without RVOTO. The time with persistent organ dysfunction (TPOD) at 28 days after surgery was similar among patients who had a RVOTO event, before CPB initiation or after CPB separation, compared to those who did not.
CONCLUSIONS: RVOTO is common in cardiac surgery. However, it is not associated with longer TPOD.