手术室中心脏不停跳心包剥脱术后超声心动图变化  

Dynamic Transesophageal Echocardiographic Changes Before and After Off-pump Pericardiectomy in Patients With Constrictive Pericarditis in the Operating Room

作　　者：陈宣伶 秦学伟 赵欣 董超 姚兰 CHEN Xuanling;QIN Xuewei;ZHAO Xin;DONG Chao;YAO Lan(Department of Anesthesiology,Peking University International Hospital,Beijing(102206),China)

机构地区：[1]北京大学国际医院麻醉科,北京市102206 [2]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院心外科

出　　处：《中国循环杂志》2023年第1期87-90,共4页Chinese Circulation Journal

摘　　要：目的:探讨经食道超声心动图评估手术室中心脏不停跳心包剥脱术前、术后左心室舒张功能变化的价值。方法:选取2017年5月至2020年11月本院收治的30例缩窄性心包炎在全身麻醉下行心包剥脱术患者。分别在心包剥脱术前、术后于食道中段四腔心切面、食道中段左心室长轴切面测量二尖瓣血流频谱舒张早期峰值速度(E)、舒张晚期峰值速度(A)、组织多普勒二尖瓣瓣环舒张早期峰值速度(e')、晚期峰值速度(a')、等容舒张时间(IVRT)、E/A比值和E/e'比值。结果:与术前比较,心包剥脱术后E([0.59±0.81)cm/s vs(.0.77±0.09)cm/s]、E/A比值(2.01±0.46 vs.2.76±0.77)、E/e'比值(7.65±1.32 vs.9.16±1.43)及IVRT[(95.21±2.75)ms vs.(100.44±2.12)ms]均降低(P均<0.01);心包剥脱术后A峰差异无统计学意义(P>0.05)。结论:缩窄性心包炎患者心包剥脱术后左心室舒张功能有明显改善,但仍处于舒张功能减退状态。经食道超声心动图可为缩窄性心包炎患者手术后左心室舒张功能监测、后续临床治疗、评估手术治疗效果提供更丰富的信息。Objectives:To explore the value of transesophageal echocardiography(TEE)in evaluating the changes of left ventricular diastolic function before and after pericardiectomy in patients with constrictive pericarditis.Methods:A total of 30 patients with constrictive pericarditis,who received pericardiectomy under general anesthesia in our hospital from May 2017 to November 2020,were included in this study.Spectrum of mitral orifice flow(E wave and A wave),mitral annulus tissue Doppler(e'wave and a'wave),isovolumetric diastolic time(IVRT),E/A and E/e'ratios were measured at the mid esophagus four-chamber view and mid esophagus long axis view before and after pericardiectomy,respectively.Results:Compared to baseline,E([0.59±0.81]cm/s vs.[0.77±0.09]cm/s),E/A ratios(2.01±0.46 vs.2.76±0.77),E/e'ratios(7.65±1.32 vs.9.16±1.43)and IVRT([95.21±2.75]ms vs.[100.44±2.12]ms)were significantly decreased after pericardiectomy(all P<0.01).A wave remained unchanged after pericardiectomy(P>0.05).Conclusions:The left ventricular diastolic function was improved after pericardiectomy in patients with constrictive pericarditis.TEE can provide accessible information for monitoring left ventricular diastolic function during pericardiectomy.Future studies are needed to explore the association between left ventricular diastolic function changes post pericardiectomy and outcome in these patients.

关 键 词：缩窄性心包炎 心包切除术 经食道超声心动图 左心室舒张功能 

分 类 号：R54[医药卫生—心血管疾病]