【罂粟摘要】机械通气和负荷调整对全身麻醉患者左心室整体纵向应变的影响：一项初步研究

机械通气和负荷调整对全身麻醉患者左心室整体纵向应变的影响：一项初步研究

贵州医科大学 高鸿教授课题组

翻译：陈锐   编辑：佟睿    审校：曹莹

背景

在全身麻醉和有创机械通气后用整体纵向应变(GLS)评估的左心室收缩功能的改变鲜有描述。

方法

这是一项单中心观察性研究。ASA I-II患者接受常规外科手术需要有创机械通气麻醉，进行连续经胸散斑追踪超声心动图检查：基线时，麻醉和有创机械通气后5分钟，被动抬腿后1分钟和拔管后。主要观察指标是评估左心室收缩功能的改变，用GLS评估，在麻醉和机械通气下。次要观察指标是评估在被动抬腿和拔管后的预负荷修改后GLS的变化。

结果

2016年11月至2017年7月共纳入27例患者。基线左心室射血分数 (LVEF: 60% [56-63]) 和GLS(-20.6% [-23.2/-19.2]) 在正常范围内。麻醉后，LVEF 没有改变，但GLS显示显着下降（-18.2% [-20.4/-17.1]，P<0.05）。被动抬腿后，与基线相比，GLS 显着受损（-17.6% [-19.7/-15]，P<0.05），7名（26%）患者出现收缩功能受损（GLS >-16%）。拔管后GLS与基线相似（-21.7% [-23.1/-19.5]，P>0.05）。

结论

对于没有心血管合并症但仍处于正常范围内的患者，在全身麻醉和有创机械通气后，用 GLS 评估的收缩功能受损。

原始文献来源

Cinotti R、Le Tourneau T、Grillot N、Rooze P、Millour P、Asehnoune K.Influence of mechanical ventilation  and loading modifications on left ventricular  global longitudinal strain in patients  undergoing general anesthesia: a pilot study.[J]Minerva Anestesiol 2020;86:712-8. DOI: 10.23736/S0375-9393.20.14079-3 

Influence of mechanical ventilation  and loading modifications on left ventricular global longitudinal strain in patients  undergoing general anesthesia: a pilot study

ABSTRACT

BACKGROUND: The modifications of left ventricular systolic function assessed with global longitudinal strain (GLS) after general anesthesia and invasive mechanical ventilation are poorly described.

METHODS: This was a single-center observational study. ASA I-II patients undergoing routine surgical procedures requiring anesthesia with invasive mechanical ventilation had serial trans-thoracic speckle-tracking echocardiography: at baseline, five minutes after anesthesia and invasive mechanical ventilation, one minute after passive leg raising and after extubation. The primary objective was to evaluate the modification of left ventricular systolic function, assessed with GLS, under anesthesia and mechanical ventilation. Secondary objectives were to evaluate the alterations of GLS after pre-load modifications with passive leg raising and after extubation.

RESULTS: From November 2016 to July 2017, 27 patients were included. Baseline left ventricular ejection fraction (LVEF: 60% [56-63]) and GLS (-20.6% [-23.2/-19.2]) were within normal ranges. After anesthesia, LVEF was not altered but GLS showed a significant decrease (-18.2% [-20.4/-17.1], P<0.05). After passive leg raising, GLS was significantly impaired compared with baseline (-17.6% [-19.7/-15], P<0.05) and seven (26%) patients presented systolic function impairment (GLS >-16%). GLS was similar to baseline after extubation (-21.7% [-23.1/-19.5], P>0.05).

CONCLUSIONS: Systolic function assessed with GLS is impaired after general anesthesia and invasive mechanical ventilation in patients without cardiovascular co-morbidities but remains within normal range.

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