대동맥판협착 환자에서 중심정맥압과 폐모세혈관쐐기압의 관계

Abstract

BACKGROUND: Hemodynamic monitoring during aortic valve replacement in patients with aortic stenosis is controversial and there are little prospective data on which to base an enlightened clinical decision. The relationship between central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) was examined in patients with aortic stenosis. METHODS: 30 patients with aortic stenosis who underwent aortic valve replacement were examined. For each patient, simultaneous measurements of CVP, pulmonary artery diastolic pressure (PADP) and PCWP were made at pre-and post-cardiopulmonary bypass. After cardiopulmonary bypass, measurement of left atrial pressure(LAP) was made. RESULTS: The PCWP correlated well with PADP(r=0.86 p<0.01, r=0.79 p<0.01) and LAP (r=0.89 p<0.01) at pre- and post-bypass. The CVP did not correlate with PADP(r=0.22 p>0.05, r=0.45 p>0.05), PCWP(r=0.39 p<0.01, r=0.53 p<0.01) and LAP(r=0.53 p<0.05) at pre- and post-bypass. The changes in CVP and PCWP also correlated poorly at pre- and post-bypass (r=0.16 p>0.05, r=0.51 p<0.05). CONCLUSIONS: This study confirmed the disparities between CVP and PCWP which were anticipated in aortic stenosis. This disparity seems due to marked differences between either compliance or function of the two ventricles. Therefore, CVP monitoring in aortic stenosis is limited value and may mislead in management.