经食管超声心动图在神经外科坐位手术中的初步应用探讨  

Transesophageal echocardiography to detect right-to-left shunt in neurosurgical patients in the sitting position

作　　者：高敬[1] 华琦[1] 李晓辉[1] 王彩荣[1] 马挺[2] 叶新[2] 

机构地区：[1]首都医科大学宣武医院心脏中心,北京100053 [2]首都医科大学宣武医院麻醉科,北京100053

出　　处：《首都医科大学学报》2012年第4期462-464,共3页Journal of Capital Medical University

摘　　要：目的探讨经食管超声心动图(transesophageal echocardiography,TEE)在神经外科坐位手术中的应用价值。方法神经外科行坐位肿瘤切除术的6例患者,应用TEE观察患者是否存在卵圆孔未闭及房、室间隔缺损等分流性或潜在分流性情况,麻醉后应用TEE引导中心静脉导管位置,术中TEE观察心脏中是否存在空气栓子,并指导处理排气。结果 6例患者TEE均可清晰显示上腔静脉置管情况,可明确导管尖端位置。6例患者中有5例在手术开始时即可监测到大量气体自上腔静脉进入右心房,其中3例于左心室内发现空气栓子,考虑卵圆孔未闭及肺动静脉瘘所致。由于能够及时发现空气栓子并指导排气,所有病例均无气栓合并症出现。结论 TEE除常规应用于心脏外科手术外,也应成为坐位手术的必备监测手段。To evaluate the efficacy of intraoperative transesophageal echocardiography （TEE） to detect right-to-left shunting in patients undergoing neurosurgical procedures while in the sitting position. Methods six patients scheduled for neurosurgery in the sitting position were investigated, venous air embolism（VAE） and paradoxical air embolism （PAE） were continuously monitored by cardiac two-dimensional 4-chamber view using transesophageal echocardiography （TEE）. Results Microbubbles in the right atrium appeared in all patients. In 3 patents, air appearance in all cavities of the heart was found. Conclusion TEE would be one of the most important monitoring methods not only in cardiac surgery, but also in neurosurgical procedures in the sitting position.

关 键 词：经食管超声心动图 坐位手术 空气栓子 

分 类 号：R540.45[医药卫生—心血管疾病]