应用经食道超声心动图评估局部肺血流的新方法  

作　　者：Yuichi Yatsu Toshihito Tsubo Hironori Ishihara Hitomi Nakamura Kazuyoshi Hirota 吴洁(译) 

机构地区：[1]Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki, Aomori-ken, Japan [2]不详

出　　处：《麻醉与镇痛》2009年第3期41-45,共5页Anesthesia & Analgesia

摘　　要：背景我们已经报道过在试验狗模型中应用经食道超声心动图探测不张肺局部血流的新方法。为证实此方法的有效性，我们就该方法对肺局部血流变化的探测能力进行了研究。方法14只麻醉后机械通气的杂种狗随机分为异丙肾上腺素组和多巴胺组，每组7只。为造成肺不张损伤模型，将60ml／kg生理盐水输入左侧胸膜腔。由脉冲多普勒推导出速度时间积分（VTI）作为评价不张肺损伤血流的指标。为研究此方法对于肺血流变化的反应程度，在按0．05μg·kg^-1·min^-1输注异丙肾上腺素（作为肺血管扩张剂）和按10μg·kg^-1·min^-1输注多巴胺（作为肺血管收缩剂）时测量收缩期VTI和肺分流比（Qs／Qt）。结果应用异丙肾上腺素后VTI和Qs／Qt均显著增加，且VTI变化百分数和Qs／Qt存在显著的相关性（r^2=0．50，P〈0．001）．而VTI和Qs／Qt在应用多巴胺后均无改变。结论经食道超声心动图可有效用于肺不张局部肺血流变化的检测。BACKGROUND： We report a novel method to estimate regional blood flow in the atelectatic lung using transesophageal echocardiography in an experimental dog model. To verify the efficacy of the method, we investigated the ability of this experimental model to detect changes in regional pulmonary blood flow. METHODS： Fourteen anesthetized and ventilated mongrel dogs were randomized into an isoproterenol group （n =7） or a dopamine group （n =7）. To produce an atelectafic lesion, 60 ml/kg of saline was infused into the left pleural space. The velocity time integral （VTI） derived from pulse Doppler was evaluated as an index of blood flow in the atelectafic lesion. To investigate the response of the method to changes in blood flow, the VTI and the shunt fraction （Qs/Qt） were measured during systemic administration of isoproterenol 0. 05 μg·kg^-1·min^-1 （as a pulmonary vasodilator） and dopamine 10 μg·kg^-1·min^-1 （as a pulmonary vasoconstrictor）. RESULTS： Both VTI and Qs/Qt were increased significantly by isoproterenol administration. There was a significant correlation between the percentage changes of VTI and Qs/Qt with isoproterenol administration （r^2 =0. 50, P 〈0. 001 ）. Both VTI and Qs/Qt were unchanged during administration of dopamine. CONCLUSIONS： Transesophageal echocardiography may be useful in detecting changes in regional pulmonary blood flow in an atelectatic lesion.

关 键 词：经食道超声心动图 肺血流 异丙肾上腺素 评估 血流变化 肺血管扩张剂 脉冲多普勒 血管收缩剂 

分 类 号：R540.45[医药卫生—心血管疾病] R541.9[医药卫生—内科学]