经食管超声测量肺静脉血流频谱评估复杂先天性心脏病患儿术中左心房压力的可行性  

Feasibility of measuring pulmonary venous blood flow spectrum by transesophageal ultrasound in evaluating intraoperative left atrial pressure in pediatric patients with complex congenital heart disease

作　　者：王慧 左维嵩[2] 费建[1] 莫绪明[3] 仲山 Wang Hui;Zuo Weisong;Fei Jian;Mo Xuming;Zhong Shan(Department of Anesthesiology,Children′s Hospital of Nanjing Medical University,Nanjing 210008,China;Department of Ultrasonography,Children′s Hospital of Nanjing Medical University,Nanjing 210008,China;Department of Cardio-Thoracic Surgery,Children′s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院麻醉科,南京210008 [2]南京医科大学附属儿童医院超声科,南京210008 [3]南京医科大学附属儿童医院心胸外科,南京210008

出　　处：《中华麻醉学杂志》2022年第2期195-198,共4页Chinese Journal of Anesthesiology

摘　　要：目的:评价经食管超声测量肺静脉血流频谱评估复杂先天性心脏病患儿术中左心房压力(LAP)的可行性。方法:全麻下行手术治疗且术中需进行LAP监测的复杂先天性心脏病患儿25例,性别不限,年龄<3岁,ASA分级Ⅲ或Ⅳ级,心功能分级Ⅲ或Ⅳ级。术中通过经食管超声观察患儿左侧肺静脉血流频谱,于CPB停机后15 min时测量S波峰值速度(PV_(S))、D波峰值速度(PV_(D))、AR波峰值速度(PV_(AR))和舒张期肺静脉血流减速时间(DT_(D)),计算S波与D波峰值速度比值(S/D比值),测量连续3个心动周期,取平均值。同时通过左房测压管测量LAP。PV_(S)、PV_(D)、PV_(AR)、DT_(D)、S/D比值与LAP行Pearson相关分析。结果:PV_(S)、PV_(D)、PV_(AR)和S/D比值与LAP无相关性(r分别为-0.06、0.21、0.19、-0.38,P>0.05),而DT D与LAP呈负相关(r=-0.84,P<0.05)。结论:经食管超声测量DT_(D)可用于评估复杂先天性心脏病患儿术中LAP。Objective To evaluate the feasibility of measuring pulmonary venous blood flow spectrum by transesophageal ultrasound in assessing intraoperative left atrial pressure(LAP)in pediatric patients with complex congenital heart disease.Methods Twenty-five pediatric patients with complex congenital heart disease of either sex,aged<3 yr,of American Society of Anesthesiologists physical statusⅢorⅣ,with New York Heart Association classⅢorⅣ,undergoing surgery with general anesthesia and requiring LAP monitoring during surgery,were selected.Transesophageal echocardiography was used to record the left pulmonary venous blood flow spectrum during surgery.S wave velocity(PVS),D wave velocity(PVD),AR wave velocity(PVAR),and deceleration time of pulmonary venous diastolic flow(DTD)were measured at 15 min after termination of CPB.The ratio of S wave peak velocity to D wave peak velocity(S/D ratio)was calculated.Measurement was carried out for 3 consecutive cardiac cycles,and the average value was calculated.The LAP was simultaneously measured through the left atrial piezometer.Pearson correlation analysis was performed between PV_(S),PV_(D),PV_(AR),DT_(D),S/D ratio and LAP.Results PV_(S),PV_(D),PV_(AR) and S/D ratio had no correlation with LAP(r=-0.06,0.21,0.19,-0.38,respectively,P>0.05),while DTD was negatively correlated with LAP(r=-0.84,P<0.05).Conclusions DTD measured by transesophageal ultrasound can be used to evaluate intraoperative LAP in pediatric patients with complex congenital heart disease.

关 键 词：超声检查 肺静脉 心房压 心脏缺损 先天性 

分 类 号：R726.5[医药卫生—儿科]