左心室辅助装置植入术围术期经食道超声心动图的应用研究  

The Perioperative Application Values of Transesophageal Echocardiography During the Implantation of Left Ventricular Assist Device

作　　者：施怡声[1] 朱振辉[1] 王浩[1] 王现强[2] 陈海波[2] 杜娟[3] 胡盛寿[2] SHI Yisheng;ZHU Zhenhui;WANG Hao;WANG Xianqiang;CHEN Haibo;DU Juan;HU Shengshou(Ultrasound Imaging Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院超声影像中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院成人外科中心,北京市100037 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院术后恢复中心,北京市100037

出　　处：《中国循环杂志》2021年第6期574-578,共5页Chinese Circulation Journal

摘　　要：目的:探讨经食道超声心动图(TEE)对左心室辅助装置(LVAD)植入术围术期的应用价值。方法:回顾性分析2018年1月至2020年12月在中国医学科学院阜外医院行“永仁心”LVAD(重庆永仁心医疗器械有限公司)植入术的12例患者的围术期TEE检查结果及临床资料。所有患者均在LVAD植入前、植入后即刻及转入重症监护室1 h后行TEE检查,主要监测指标包括心房和心室内径、心功能、套管位置、泵功能等。结果:12例患者均为男性,平均年龄为(43.3±8.6)岁。术前诊断扩张型心肌病7例、冠心病心力衰竭3例、心肌致密化不全1例、二尖瓣脱垂致心力衰竭1例;合并不同程度右心功能不全11例、肺动脉高压9例、卵圆孔未闭3例、左心室心尖部室壁瘤1例;少量以上二尖瓣反流11例、少量以上三尖瓣反流9例;主动脉瓣反流量均≤少量;均无心内血栓。所有患者均在体外循环下顺利完成LVAD植入。植入后TEE监测显示,患者左心室舒张末期内径明显减小[术前vs.入重症监护室后1 h:(77.4±7.3)mm vs.(68.3±6.4)mm,P<0.05],套管位置良好;根据TEE监测结果可将泵功能优化至合适泵输出量。结论:LVAD可使左心有效卸负荷。TEE可在LVAD植入前确认诊断以及LVAD植入后监测手术疗效、协助优化泵功能、排除外科并发症等。由于该手术在我国的开展仍处于起步阶段,需要积累更多TEE应用经验。Objectives:To explore the perioperative application values of transesophageal echocardiography(TEE)during the implantation of left ventricular assist device(LVAD).Methods:This is a retrospective analysis.Perioperative TEE examination results and clinical data of 12 patients,who underwent LVAD implantation with EVAHEART I(‘Yongrenxin’)in our hospital from January 2018 to December 2020,were analyzed.TEE examinations were performed before and after LVAD implantation and one hour after transfer to intensive care unit(ICU).TEE was used to monitor and evaluate changes in cardiac size and function after the implantation and confirm the proper positioning of inflow and outflow pipelines.Results:All patients were male with a mean age of(43.3±8.6)years.Preoperative diagnosis included dilated cardiomyopathy(n=7),coronary heart disease-associated heart failure(n=3),myocardial noncompaction(n=1),and mitral valve prolapse-induced heart failure(n=1).Patient comorbidities included varying degrees of right ventricular dysfunction(n=11),pulmonary hypertension(n=9),patent foramen ovale(n=3),left ventricular apical aneurysm(n=1),moderate and higher degrees of mitral valve regurgitation(n=11)or tricuspid valve regurgitation(n=9).All implantations were successfully performed under cardiopulmonary bypass.There was significant change in the left ventricular end diastolic diameter([77.4±7.3]mm vs.[68.3±6.4]mm,P<0.05).The pump function was optimized under TEE and further monitored by TEE one hour after transfer to the ICU.Conclusions:LVAD can effectively unload the left heart.TEE can be used to confirm the diagnosis before implantation,monitor the surgical efficacy after implantation,assist in optimizing the pump function,and rule out surgical complications.Since this operation is still in its infancy in our country,more experience on LVAD implantation together with the use of TEE should be accumulated.

关 键 词：左心室辅助 植入手术 经食道超声心动图 围术期 

分 类 号：R54[医药卫生—心血管疾病]