经食管超声心动图监测心肺转流对心脏手术患者肝静脉血流的可行性  

The suitubility of cardiopulmonary bypass on hepatic vein hemodynamics by transesophageal echocardiography in patients

作　　者：严金燕[1] 史宏伟[1] 胡小菊[1] 魏海燕[1] 赵雅梅[1] 葛亚力[1] 

机构地区：[1]南京医科大学附属南京医院南京市第一医院麻醉科,210006

出　　处：《临床麻醉学杂志》2013年第7期637-639,共3页Journal of Clinical Anesthesiology

基　　金：南京市卫生青年人才培养工程(第一层次)-宁卫科(2011)42号

摘　　要：目的观察心肺转流(CPB)前后心脏手术患者肝静脉血流动力学的变化。方法选择18例择期行冠状动脉旁路移植术和心脏瓣膜置换术患者,记录全麻诱导后(T0)、CPB开始后5min(T1)、30min(T2)及停机后30min(T3)血流动力学变化[HR、MAP、CVP、心脏指数(CI)等]及使用经食管超声心动图(TEE)监测肝静脉直径(DHV)、肝静脉血流量(QHV)和最大流速(Vmax)。结果与T0时比较,T1～T3时MAP,T1、T2时DHV明显下降(P<0.05),QHV明显升高(P<0.05),T3时QHV明显下降(P<0.05)。结论 CPB期间QHV较术前有所增加,停机后早期QHV较术前明显下降。术中使用TEE监测肝静脉流量是可行的,TEE监测QHV为监测内脏灌注提供新的方法。Objective The present study was undertaken to observe the changes in hepatic vein hemodynamics before and after cardiopulmonary bypass（CPB）. Methods The general hemodynamics （HR,MAP, CVP, CI, et al） were recorded and the related hepatic vein flow index （hepatic vein diameter, DHV and hepatic vein flow, QHV ） were observed by transesophageal echocardiography （TEE） in 18 patients undergoing coronary artery bypass grafting or valve replacement surgery. Data were collected after general induction, 5 minutes after cardiopulmonary bypass, 30 minutes after cardiopulmonary bypass, and 30 minutes after off-pump. Results Compared with To, MAP were significantly reduced at T1-T3, DHV were significantly reduced at T1, T2, QHV were significantly increased （P〈0.05） ;QHV were significantly reduced at T3 （P〈0.05）. Conclusion The hepatic vein volume increased during CPB and decreased after off-pump compared with after induction. TEE could be suitable for monitoring hepatic vein flow during surgery. TEE may offer a feasible method for monitoring visceral perfusion.

关 键 词：心肺转流 肝静脉血流 经食管超声心动图 

分 类 号：R654.2[医药卫生—外科学]