经食道超声心动图在休克患者麻醉循环管理中的应用效果  

Application effect of transesophageal echocardiography on anesthetic circulation management in patients with shock

作　　者：李强[1] 卢彬[1] 余璇[1] 李俊[1] 郑业英[1] 郭飞[1] 叶勇[1] 缪冬梅[1] 

机构地区：[1]四川省自贡市第四人民医院麻醉科,自贡市643000

出　　处：《广西医学》2017年第5期630-632,共3页Guangxi Medical Journal

基　　金：四川省自贡市科技局科研重点立项课题(2015SF04)

摘　　要：目的探讨经食道超声心动图(TEE)在休克患者麻醉循环管理中的应用效果。方法对行外科手术治疗的38例休克患者进行TEE监测,记录TEE阳性发现率及并发症发生率,比较存在TEE阳性发现的患者循环纠正前后的HR、SBP、平均动脉压(MBP)、左室舒张末面积及下腔静脉直径。结果 TEE监测阳性发现率为60.5%(23/38),其中提示容量不足14例(60.8%),左心和右心功能不全4例(17.4%),左房血栓心脏瓣膜疾病2例(8.7%),左室心肌节段运动功能异常2例(8.7%)及心包积液1例(4.3%)。循环对症纠正后,23例存在TEE阳性发现的患者HR低于循环纠正前,而SBP、MBP、左室舒张末期面积及下腔静脉直径均高于循环纠正前(P<0.05)。所有患者均未出现食道穿孔等严重并发症。结论由麻醉医师对休克患者行术中TEE监测,能及时提供对循环管理和决策有指导性意义的信息。Objective To investigate the efficacy of transesophageal echocardiography（TEE） applied to the anesthetic circulation management in patients with shock. Methods TEE monitoring was performed in 38 patients with shock receiving surgical therapy. The rate of＂ positive findings in TEE and the incidence rate of complications were recorded. HR, SBP, mean arterial pressure （MAP） , left ventricular end-diastolic, volume（LVEDV） and the diameter of inferior vena cava before circulatory recovery were compared with those after circulatory recovery among the patients with TEE positive findings. Results The rate of positive findings in TEE was 60.5% （23/38）. The findings included hypovolemia（n = 14,60.8% ） ,left and right cardiac insufficiency（n = 4,17.4% ） ,left atrial thrombus and valvular disease （n = 2,8.7% ） ,left ventricular segmental wall motion abnormality （n = 2,8.7% ） and pericardial effusion （n = 1,4.3% ）. After treatment, in 23 patients （21/23,91.3%） with positive finding in TEE, HR was lower than that before cyclic correction, and SBP, MAP, LVEDV and diameter of inferior vena cava were higher than those before cyclic correction （P 〈 0.05 ）. No serious complications, such as esophageal perforation, occurred in any patients. Conclusion TEE monitoring by anesthesiologists for the patients with shock during operation can provide a timely guidance to the circulation management,and obtain a decisional effect on circulation management.

关 键 词：休克 经食道超声心动图 麻醉 手术 循环管理 

分 类 号：R441.9[医药卫生—诊断学]