术前经胸超声心动图术中经食管超声心动图对二尖瓣反流的分级对比  

Comparision of transthoracic and prepump intraoperative transeophageal echocardiography in the grading assessment of mitral regurgitation

作　　者：张晶[1] 王剑辉[2] 王伟鹏[2] 李立环[2] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉科 [2]中国医学科学院阜外心血管病医院麻醉科,北京100037

出　　处：《心肺血管病杂志》2009年第4期244-247,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:通过术前经胸超声心动图(POTTE)与术中体外循环前经食管超声心动图(IOTEE)对二尖瓣反流(MR)分级的对比,评价2种检查结果有无差异、原因及影响因素。方法:回顾性调查研究200例MR手术患者,对比POTTE与IOTEE的MR分级诊断。结果:2者结果一致者143例(占71.5%,Kappa=0.56,r=0.71,P<0.01)。与POTTE相比,IOTEE分级加重者19例(9.5%),多见于瓣膜器质性损害和偏心性反流;IOTEE分级减轻者38例(19%),多见于功能性相对关闭不全和中心性反流。在无～微量及严重MR者,2种检查结果较一致;而在少、中量MR,2者差异较大。IOTEE时有外科意义(中～严重)MR由132例(66%)减至111例(56%),有减轻MR分级倾向。与术前相比,麻醉后患者循环改变明显(P<0.01)。结论:多数MR患者,POTTE与IOTEE分级诊断结果一致,但这2种检查不能相互替代。POTTE分级结果更能反映生理负荷下MR严重程度。IOTEE有确诊作用,但分级MR时需参考术前循环指标。Objective： The agreements between preoperative transtboracic echocardiography （POTIE） and prepump intraoperative transeophageal echocardiography （IOTEE） were examined in the grading assessment of mitral regurgitation （MR） and variables associated with grading discrepancies. Method：Tbe POTTE and prepump IOTEE studies of 200 MR patients undergoing cardiovascular surgery were compared. Agreement and correlation in assessment of MR severity were evaluated. Result： The concordance between two techniques in MR grading was fair （ Kappa = 0.56, r = 0.71, P 〈 0.01）. Comparing POTTE, in 143 cases （71.5%） the grading of MR by IOTEE kept same, however 19 cases （9.5%） worsen and 38 cases （19%） improved. The discrepancies were found especially in patients with eccentric jet or functional MR. The hemodynamics changed significantly （ P 〈 0.01 ） during IOTEE with effects on severity of MR. Generally trend in grading of MR by IOTEE reduced due to anesthesia. Conclusion： There was fair agreement in MR assessment between POTTE and prepump IOTEE, but these two techniques can not be replaced by each other. The grading of MR by POTTE is under physical loading with guidance for surgical procedure. Prepump IOTEE was used to confirm preoperative diagnosis however anesthetic induced changes in apparent the severity of MR. Cardiac surgeon and anesthesiologist should be aware of the difference between these two methods to make perfect decision,

关 键 词：术前经胸超声心动图 术中经食管超声心动图 二尖瓣反流 

分 类 号：R540.45[医药卫生—心血管疾病]