经食道超声心动图监测在心脏瓣膜手术麻醉中的临床应用  

Clinical application of transesophageal echocardiography monitoring in anesthesia of cardiac valve surgery

作　　者：李强[1] 卢彬[1] 缪冬梅[1] 余璇[1] 郭飞[1] 王君[1] 范彬[1] 郑业英[1] Li Qiang Lu Bin Miao Dongmei Yu Xuan Guo Fei Wang Jun Fan Bin Zheng Yeying(Department of A nesthesiology , Zigong Municipal Fourth People＇s Hospital, Zigong , Sichuan 643000, Chin)

机构地区：[1]自贡市第四人民医院麻醉科,四川643000

出　　处：《现代医药卫生》2017年第2期194-197,共4页Journal of Modern Medicine & Health

摘　　要：目的探讨经食道超声心动图(TEE)监测在心脏瓣膜手术方式选择、手术效果评估、左心排气及麻醉循环管理中的应用价值。方法选取2014年5月至2015年6月该院收治的美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级、拟行手术治疗的心脏瓣膜疾病患者40例,按随机数字表法分为TEE监测组(T组)和传统监测组(C组),各20例。记录T组应用TEE监测后补充或完善术前诊断、改变或调整手术方案的病例数,评估手术效果,监测左心气体程度及排除情况。比较T组术前和术后面积减少分数(FAC)、速度时间积分(AVTI)、每搏量(SV)、心脏指数(CI)。比较两组患者心脏复跳到体外循环(CPB)停机时间,停机后即刻(T0),10(T1)、30(T2)、60 min(T3)各个时点平均动脉压(MAP)和乳酸值。结果 T组补充术前诊断2例,调整拟行手术方式4例,术后无一例发生瓣叶活动异常、瓣周漏及过瓣血流明显加速等严重手术并发症。T组有1例在三尖瓣重度反流成型术后又发生重度反流,无适合的人工瓣膜,未行特殊处理;T组所有患者心脏复跳后左心均发现不同程度气体,充分排气,术后随访未发现气体栓塞所致相关并发症;T组中无一例发生TEE操作并发症。所有患者均康复出院。T组患者术后FAC、AVTI、SV、CI分别为(0.50±0.05)、(25.1±6.5)cm、(71.0±6.0)m L、(2.90±0.74)L/(min·m2),与术前[分别为(0.43±0.08)、(24.5±7.8)cm、(65.0±8.0)m L、(2.70±0.87)L/(min·m2)]比较,差异均有统计学意义(P<0.05)。T组心脏复跳到CPB停机平均时间为(26.75±5.66)min,C组为(28.99±5.96)min,两组比较,差异有统计学意义(P<0.05)。T组患者停机后各时刻MAP值比较,差异均无统计学意义(P>0.05),而C组患者停机后各时刻MAP值比较,差异有统计学意义(P<0.05)。两组患者停机后各时刻乳酸值比较,差异均有统计学意义(P<0.05)。结论 TEE监测在心脏瓣膜手术前再次评价瓣膜情况,术后即刻评估手术效果,指导心内排气�Objective To investigate the application value of transesophageal echocardiography（TEE） monitoring in the selection of cardiac valve surgery mode,evaluation of operative effect,left heart exhaust and anesthesia circulation management of heart valve operation. Methods Forty ASA grade Ⅱ -Ⅲ patients with heart valve disease undergoing surgical treatment in our hospital from May 2014 to June 2015 were randomly divided into the TEE monitoring group（T） and conventional monitoring group（C） according to the random number table method,20 cases in each group. The group T replenished or perfected preopera-tive diagnosis,changed or adjusted the case number of operation scheme,evaluated the operative effect,monitored the left heart gas degree and excluding situation. FAC,AVTI,SV and CI in the group T were compared between before and after operation. The time from heart rebeating to CPB machine stopping,MAP and lactic acid values at time points of instantly after CBP machine stopping（T0）,at 10 min（T1）,30 min（T2）,60 min（T3） after CBP machine stopping were compared between the two groups.Results In the group T,2 cases replenished the preoperative diagnosis,4 cases adjusted the planning operation mode,and no case developed the serious postoperative complications such as postoperative valve movement abnormality,perivalvular leakage or obvious acceleration of transvalve blood flow. One case in the groups T appeared severe reflux after tricuspid severe reflux forming operation without special treatment due to no suitable artificial valve; in all cases of the group T,different degrees of gas were found in the left heart after heart rebeating,sufficient exhaust was performed,no related complications caused by gas embolism were found during postoperative follow up. No case of TEE operating complication occurred in the group T. All cases were cured and discharged with rehabilitation. Postoperative FAC,AVTI,SV and CI in the group T were（0.50±0.05）,（25.1±6.5）cm,（71.0±6.0）m L and（2.90±0.74�

关 键 词：超声心动描记术 经食管 监测 手术中 心脏瓣膜/外科学 麻醉 

分 类 号：R971.2[医药卫生—药品]