术中经食管超声心动图在室间隔缺损修补中的应用价值  

Application Value of Intraoperative Transesophageal Echocardiography in Repairing Ventricular Septal Defect

作　　者：赵婉玉 赵苗 王奖 李丽 李维君 周运飞 骆志玲 Zhao Wanyu;Zhao Miao;Wang Jiang;Li Li;Li Weijun;Zhou Yunfei;Luo Zhiling(Department of Ultrasound,Fuwai Yunnan Cardiovascular Hospital,Kunming 650032,China)

机构地区：[1]云南省阜外心血管病医院超声科,昆明市650032

出　　处：《中国超声医学杂志》2023年第8期887-890,共4页Chinese Journal of Ultrasound in Medicine

基　　金：国家自然科学基金(No.31960133);云南省教育厅基金(No.2022J0271);云南省阜外心血管病医院人才托举计划项目(No.2023RCTJ-QN002)。

摘　　要：目的探讨术中经食管超声心动图(iTEE)在室间隔缺损(VSD)术前诊断及术中监测中的应用价值。方法收集1428例接受外科手术的VSD患者资料,于术前常规行经胸超声心动图(TTE)检查、术中应用iTEE监测。术前iTEE观察缺损部位、大小、瓣膜情况等,并与TTE比较。修补完成后、体外循环(CPB)停机前评价VSD修补效果、残余分流(RS)及其他病变情况。术后所有患者均进行定期随访。结果在1428例VSD患者中,与手术结果对比,iTEE诊断VSD分型的准确度较TTE稍高(98.1%vs.97.4%,P>0.05);iTEE及TTE测量的VSD大小与术中探查结果均有显著相关性(r=0.922,P<0.001;r=0.911,P<0.001);修补完成后iTEE共发现123例(8.6%)RS,其中42例(2.9%)再次CPB修补,手术完成后最终RS 85例(6.0%)。结论iTEE可用于明确术前诊断,手术完成后及时评估手术情况,为术者对残余异常的处理提供重要参考,在外科术中具有较好的应用价值。Objective To investigate the value of intraoperative transesophageal echocardiography(iTEE)in ventricular septal defect(VSD)preoperative diagnosis and intraoperative monitoring.Methods The data of 1,428 VSD patients underwent surgery were collected,routine transthoracic echocardiography(TTE)was performed before surgery,and iTEE monitoring was applied during operation.The site and size of defect,valvular condition and so on were observed by iTEE before surgery and compared with TTE.The VSD repair effect,residual shunt(RS)and the other lesions were evaluated after repair completed and before the cardiopulmonary bypass(CPB)shutdown.All patients were followed up periodically after operation.Results Among 1,428patients,the accuracy of iTEE was slightly higher than TTE in VSD classification when compared with surgical results(98.1%vs.97.4%,P>0.05).The size of VSD measured by iTEE and TTE was correlated with surgical results significantly(r=0.922,P<0.001;r=0.911,P<0.001).A total of 123cases(8.6%)of RS were found by iTEE after repair,among which 42cases(2.9%)were repaired again with CPB,and 85cases(6.0%)of RS were remained finally after operation.Conclusions iTEE can be used for preoperative diagnosis confirmation,and evaluate the surgical effect after surgery in time,which provide important information for the residual abnormalities treatment,have good application value in surgery.

关 键 词：术中经食管超声心动图 室间隔缺损 残余分流 经胸超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]