经食管超声观察全膝关节置换术中松放止血带对患者心脏功能的影响  

Effects of tourniquet on cardiac function in total knee arthroplasty with trans-esophageal echocardiography

作　　者：冯磊[1] 张晓光[1] 杨庆国[1] 王庚[1] 

机构地区：[1]北京积水潭医院麻醉科,100035

出　　处：《中华医学杂志》2013年第47期3755-3757,共3页National Medical Journal of China

摘　　要：目的采用经食管超声（TEE）观察全膝关节置换术（TKA）松放止血带对心脏功能的影响。方法选择2011年9月至2012年2月北京积水潭医院矫形骨科20例在全麻下行TKA的患者，术中用TEE观察手术开始后30min，松放止血带即刻，松放后5、10、15min各时间段心腔内栓子的发生率、程度以及心功能的变化。结果所有患者在松放止血带后右心房均出现了不同程度的“流星样”微栓影像，松放止血带5min后，“流星样”影像最为明显，10min后开始减少，但仍普遍存在，15min后进一步下降。松放止血带5、10、15min心脏左室舒张末期面积为（7．62±0．54）、（7．86±0．46）、（8．55±0．56）cm。均比松放止血带前（9．80±0．48）cm2有显著性改变（P〈0．01）。面积减少分数（FAC）自松放止血带5min点出现显著性的下降（P〈0．01）。结论应用TEE可观察到TKA术中释放止血带后大量流星样“微栓”并伴有心脏功能的减低。Objective To employ trans-esophageal echocardiography （TEE） to observe the toumiquet＇s influence on cardiac function in total knee arthroplasty （TKA）. Methods Twenty ASA Ⅰ -Ⅱ patients undergoing TKA under general anesthesia from September 2011 to February 2012 at Department of Orthopedics, Beijing Jishuitan Hospital were selected. Tourniquet was loosened at 30 minutes after the start of TKA. And TEE was employed to observe the occurrence rate and degree of intra-eardiae embolus and the changes of cardiac function at 5, 10 and 15 min post-loosening respectively. Results Different degrees of ＂meteor-shaped＂ microemboli images appeared in right atriums of all patients. The ＂meteor shape＂ image was the most obvious after loosening for 5 min. It started to decrease after 10 min, persisted generally and declined further after 15 min. The left ventricular areas at end diastole （LVAd） after loosening tourniquet for 5, 10 and 15 rain were （7. 62±0. 54）, （7. 86 ±0. 46） and （8.55±0. 56） cm2 respectively. And there were remarkable changes compared with the area （ 9. 80±0. 48 ） cm2 pre-loosening （ P 〈 0.01 ）. The fractional area change （FAC） showed obvious decrease since loosening for 5 rain （P 〈 0. 01 ）. Conclusion Massive meteor-shaped microembolis appear on TEE with weakened cardiac function.

关 键 词：关节成形术 置换 膝 止血带 超声心动描记术 经食管 心脏功能 

分 类 号：R687.4[医药卫生—骨科学]