体外膜肺氧合下床旁经食管超声心动图引导房间隔造口术  

Bedside transesophageal echocardiography-guided atrial septostomy under extracorporeal membrane oxygenation support

作　　者：柳昂 王珂 段福建 康文英 龚俊松 平措云旦 闫朝武[1] LIU Ang;WANG Ke;DUAN Fu-jian;KANG Wen-ying;GONG Jun-song;Pingcuo-Yundan;YAN Chao-wu(Center for Structural Heart Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Anesthesiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Radiology,People’s Hospital of Xizang Autonomous Region,Lhasa 850000,China)

机构地区：[1]国家心血管病中心、北京协和医学院、中国医学科学院阜外医院结构性心脏病中心,北京100037 [2]国家心血管病中心、北京协和医学院、中国医学科学院阜外医院麻醉中心,北京100037 [3]西藏自治区人民医院放射科,西藏拉萨850000

出　　处：《中国介入心脏病学杂志》2025年第4期189-194,共6页Chinese Journal of Interventional Cardiology

基　　金：中国医学科学院北京协和医学院临床与转化创新项目(2020-I2M-C&T-B-065);中国医学科学院中央级公益性科研院所重大任务及行业支撑项目(2023-RW320-08)。

摘　　要：目的探讨体外膜肺氧合(ECMO)下床旁经食管超声心动图(TEE)引导房间隔造口术的可行性和安全性。方法纳入2020年1月至2024年10月中国医学科学院阜外医院接受静脉-动脉体外膜肺氧合(VA-ECMO)治疗下发生肺水肿患者8例(女2例、男6例)。所有患者在床旁TEE引导下穿刺房间隔,应用Inoue球囊行房间隔逐级球囊扩张(直径18~24 mm),扩张终点为左心房平均压力<15 mmHg。术后评估房间隔瘘口大小、左心房平均压力及双肺水肿改变。结果8例患者年龄(43.50±16.84)岁。所有患者均成功完成房间隔穿刺造口术,球囊扩张直径(22.75±2.68)mm,所造瘘口直径(6.31±0.37)mm,患者左心房平均压力由术前(26.63±1.77)mmHg降至术后(12.75±1.28)mmHg,差异有统计学意义(P<0.001)。术后所有患者双肺水肿及6例患者二尖瓣反流程度获得明显改善。无手术相关并发症发生。结论床旁TEE引导下房间隔造口术安全可行,可有效降低ECMO治疗过程中左心高负荷,大幅改善双肺水肿。Objective To investigate the feasibility and safety of bedside transesophageal echocardiography(TEE)-guided atrial septostomy in patients undergoing extracorporeal membrane oxygenation(ECMO)support.Methods Eight patients(2 females and 6 males)who developed pulmonary edema during VA-ECMO treatment between January 2020 and October 2024 were enrolled.All patients underwent bedside TEE-guided atrial septal puncture,followed by gradual balloon dilation using an Inoue balloon(diameter:18–24 mm).The endpoint for dilation was defined as mean left atrial pressure<15 mmHg.4Post-procedure evaluation included assessment of the septal defect size,mean left atrial pressure,and improvement in bilateral pulmonary edema.Results The mean age of all 8 patients was(43.50±16.84)years old.Atrial septostomy was successfully performed in all patients.The mean balloon dilation diameter was(22.75±2.68)mm,resulting in a mean septal defect size of(6.31±0.37)mm.The mean left atrial pressure significantly decreased from(26.63±1.77)mmHg pre-procedure to(12.75±1.28)mmHg post-procedure(P<0.001).All patients demonstrated marked improvement in bilateral pulmonary edema,and six patients also showed a significant reduction in the severity of mitral regurgitation following the procedure.No procedure-related complications were observed.Conclusions Bedside TEE-guided atrial septostomy is safe and effective for reducing left heart loading during ECMO support and improving pulmonary edema.

关 键 词：经食管超声心动图 体外膜肺氧合 房间隔造口术 左心房减压 

分 类 号：R54[医药卫生—心血管疾病]