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左心室打的血多還是右心室打的血多?


最近在研讀心輸出量測量與補液問題,順便將論壇上的舊文章整理出來。

左心室打的血多還是右心室打的血多?

liupanr戰友每有奇想,總是能啟發眾人的腦力激蕩,甚是佩服。不過這個問題可能要移樽就教於心血管版,可能比較合適,以下就初淺的認知,拋磚一下。

應該指的左右心室的stroke volume, 或者是Cardiac output比較,理論上應該是一樣,但誠如xq_zhong888戰友所言,有些解剖上變異性的分流,是會有不一致的情況發生,而這種差異性是測量的到還是測量不到呢?



目前測量心髒容積volumetry的工具綜多,對於right heart而言,金標准是MRI,不同的工具與不同的測量方法,得出來的結果就會不一樣,早期的研究,在少樣本的測量結果,兩者是趨近於相等的(小兒與成人)。


Measurement of right and left ventricular in health individuals with cine MR imaging. Radiology 1987; 163:697~702

Quantification of right ventricular function with magnetic resonance imaging in children with normal hearts and with congenital heart disease.Am Heart J 1995;130:828-37.

[續]

感謝philosophy927戰友找到解剖生理資料。第一帖中有未盡之意,就一併貼出。

肺內 分流,或所謂的生理性分流,基本上還是由右心出來的肺循環pulmonary circulation,與體循環無涉,這部份不能算入Qp/Qs(肺循環流量/體循環流量)的比較,解剖性分流,bonchial circulation, thebasian vein 與先天性心臟病分流,才能真正算入左右分流,而正常人,又只能計算前二者

thebasian vein 只佔左心輸出量的0.12~0.43%。bronchial artery 佔心輸出量的2%,有1/3經由正常的azygos or hemiazygos , intercostal vein 回到右心循環,而另2/3則透過bronchopulmonary anastomosis逕流入pulmonary vein回到左心,因此有1~2%流入左心室的血是理論上的分流量。

Contribution of thebesian veins to the physiologic shunt in anesthetized man.J Appl Physiol 20: 1148-1152, 1965;8750-7587



同意xq_zhong888戰友的觀點,因為有解剖分流的存在,故左右心博量可以不等,但這種差異甚小,以目前的測量工具,都在觀察誤差與測量誤差的範圍內,故有可能無法得到測量學上的『真憑實據』。

Cardiac MRI: accuracy of simultaneous measurement of left and right ventricular parameters using three different sequences.Clinical Physiology and Functional Imaging 27(6): 385–393.

而上篇則是個人找到最新的測量研究報告(2007年11月),其左右心輸出量與其他稍早的報告有明顯的差異,其 Qp/Qs=0.87+-0.13 ,是左>右。            

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