摘要
目的探讨经食管超声心动图(TEE)监测应用于体外循环心脏瓣膜置换术中的临床价值。方法前瞻性选取2017年1月至2019年10月自贡市第四人民医院收治的拟行手术治疗的心脏瓣膜疾病患者80例,随机分为TEE监测组(T组)和对照组(C组),各40例。T组患者术中采用TEE监测,C组患者术后采用经胸超声心动图监测。统计T组患者围术期情况,并比较T组术前和术后心脏功能[每搏量(SV)、面积减少分数(FAC)、心脏指数(CI)、速度时间积分(AVTI)]变化,比较2组患者从心脏复跳到体外循环(CPB)停机的并行循环时间,停机后即刻(T_(0))、10 min(T_(1))、30 min(T_(2))、60 min(T_(3))平均动脉压(MAP)和乳酸值。结果T组补充术前诊断4例,调整拟行手术方式8例,CPB停机前发现1例轻微二尖瓣瓣周漏,1例二尖瓣置换后瓣叶活动异常,1例三尖瓣重度反流成型术后仍发生重度反流;T组所有患者在心脏复跳后均发现左心出现不同程度气体,充分膨肺排气后,随访期间均为出现气体栓塞所致相关并发症;T组1例发生TEE操作并发症。所有患者均康复效果良好。T组患者术后SV、FAC、CI和AVTI值均明显高于术前,差异均有统计学意义(P<0.05)。T组从心脏复跳到CPB停机并行循环平均时间明显低于C组,差异有统计学意义(P<0.05)。T组患者停机后各时刻MAP值比较差异无统计学意义(P>0.05),而C组患者停机后各时刻MAP值比较,差异有统计学意义(P<0.05)。T组患者停机后各时间点乳酸值均低于C组比较,差异有统计学意义(P<0.05)。结论TEE监测能在心脏瓣膜手术前再次评估瓣膜情况从而补充或完善术前诊断,调整手术方式;术后即刻评价手术效果,及时发现瓣周漏及瓣膜活动异常;根据左室容量及室壁运动情况采取及时有效的循环管理并指导左心排气,从而缩短从心脏复跳到CPB停机的并行循环时间。
Objective To explore the clinical value of transesophageal echocardiography(TEE)monitoring in heart valve replacement after cardiopulmonary bypass(CPB).Methods A total of 80 patients with heart valve diseases undergoing elective surgery in Zigong Fourth People's Hospital between January 2017 and October 2019 were prospectively enrolled.They were randomly divided into TEE monitoring group(group T)and control group(group C),40 cases in each group.Patients in group T were monitored by TEE during operation,and patients in group C were monitored by transthoracic echocardiography after operation.The perioperative situations in group monitoring were statistically analyzed.The changes in cardiac function[stroke volume(SV),fractional area change(FAC),cardiac index(CI),aortic velocity time integral(AVTI)]before and after surgery in group T,concurrent cycle time from heart re-beating to CPB weaning,mean arterial pressure(MAP)and lactate value at immediately after shutdown(T_(0)),10 min(T_(1)),30 min(T_(2)),60 min(T_(3))between the two groups were compared.Results In group T,there were 4 cases continuing the preoperative diagnosis,8 cases adjusting the method of elective surgery,1 case with mild mitral valve leakage before CPB weaning,1 case with abnormal valve leaflet movement after mitral valve replacement,and 1 case with severe reflux after severe tricuspid valvuloplasty.In group T,there was different degrees of gas in the left heart after heart re-beating in all patients.After complete exhaust,there were no complications related to gas embolism during follow-up.In group T,there was 1 case with TEE operation complications.And the rehabilitation effect in all patients was good.The postoperative levels of SV,FAC,CI and AVTI in group T were significantly higher than those before surgery,and the differences were statistically significant(P<0.05).The concurrent cycle time from heart re-beating to CPB weaning in group T was significantly shorter than that in group C,the differences were statistically significant(P<0.05).There w
作者
卢彬
李强
余璇
叶勇
吴迪
胡明权
郑业英
LU Bin;LI Qiang;YU Xuan(Department of Anesthesiology,Zigong Fourth People's Hospital,Zigong Sichuan 643000,China.)
出处
《临床和实验医学杂志》
2021年第15期1662-1666,共5页
Journal of Clinical and Experimental Medicine
基金
自贡市科技局科研重点立项课题(编号:2016SF03)
自贡市科技局科研重点立项课题(编号:2017ZC22)
四川省卫健委科研重点立项课题(编号:18ZD024)
四川省医学科研青年创新课题(编号:Q15030)。
关键词
体外循环心脏瓣膜置换
经食管超声心动图
临床价值
Heart valve replacement after cardiopulmonary bypass
Transesophageal echocardiography
Clinical value
