经食管超声心动图对不停跳冠状动脉搭桥患者心脏功能的评估

To assess heart function of the patients undergoing off pump coronary artery bypass graft surgery by transesophageal echocardiography

目的:采用经食管超声心动图(TEE)技术对不停跳冠状动脉搭桥术(OPCABG)患者手术前后心脏功能的变化进行评价。方法:在全麻TEE和肺动脉导管监测下35例OPCABG患者,男性28例,女性7例,平均年龄(63.8±9.4)岁,体重(70.0±7.7)kg。TEE监测指标:①面积减少分数(FAC);②经左室流出道的心排血量(CO);③经二尖瓣血流频谱(TMF)的E波和A波峰值流速、E/A比率和E波减速时间(DT);④经左上肺静脉血流频谱(PVF)的S波、D波和AR波的峰值流速。记录术前和术后上述各项指标。结果:与术前比较,术后TMF的E波(55.0±13.8比69.2±17.8cm/s)、A波(53.3±17.0比61.5±16.1cm/s)和PVF的S波(37.6±13.3比48.7±14.4cm/s)、D波(31.5±8.5比39.1±9.8cm/s)和AR(15.7±5.3比19.3±4.8cm/s)波峰值速度、FAC(43.3%±13.8%比53.3%±12.5%)和CO(4.0±1.0比5.5±1.5L/min)值均显著增加(P<0.01);而E/A、DT和S/D无明显变化;使用正性肌力药组的术前E/A值和术后S/D值分别显著低于和高于不使用正性肌力药组(P<0.05);E/A<1组的术前和术后S/D值及术前AR值均显著高于E/A≥1组(P<0.05),且E/A<1组有更多比例患者需正性肌力药。结论:TEE可评价和区分OPCABG患者的心脏收缩和舒张功能;OPCABG患者普遍存在舒张功能不全,再血管化后。

Objective:To assess preoperative and postoperative heart function indices of the patients undergoing off pump coronary artery bypass graft surgery(CABG) by transesophageal echocardiography(TEE). Methods: Thirty-five anesthetized patients undergoing elective CABG and being monitored with TEE and pulmonary artery catheter were studied. They were 28 males and 7 females, mean age (63.8 ± 9.4)years and average weight(70.0 ± 7.7)kg. The criteria were as follows:① Fractional area changes(FAC); ② Cardiac output through left ventricle outflow trace(CO);③Doppler TEE studies were performed and transmitral flow(TMF) and left upper pulmonary venous flow(PVF) velocities were recorded. TMF indices including Peak early(E) and late(A) TMF velocities,deceleration time(DT) and ratios of peak velocities of E wave versus peak velocities of A waves(E/A); ④Ventricle systolic(S)and diastolic(D) forward PVF velocities and atrial systolic(AR) retro PVF velocities were measured. All of the indices were recordered,and statistical analysis was performed using Student's t-test and F test, with P value less than 0.05 statistically significant. Results: Compared with the preoperative patients, the postoperative patients had: higher TMF E wave velocity(55.0 ± 13.8 v 69.2 ± 17.8 cm/s,P < 0.01 ) and A wave velocity(53.3 ± 17.0 v 61.5 ± 16.1 cm/s, P < 0.01) and higher PVF systolic wave velocity(37.6 ± 13.3 v 48.7 ± 14.4 cm/s, P < 0.01),diastolic wave velocity(31.5 ± 8.5 v 39.1 ± 9.8 cm/s, P < 0.01) and AR wave velocity(15.7 ± 5.3 v 19.3 ± 4.8 cm/s, P < 0.01) and higher left ventricular fractional area change(43.3% ± 13.8% v 53.3% ± 12.5%,P < 0.01)and CO(4.0 ± 1.0 v 5.5 ± 1.5 L/min,P < 0.01); but changes of E/A,DT and ratio of PVF systolic to diastolic wave velocity(S/D) were of no significance. Compared with patients in the group using inotropic agent,those in the group without inotropic agent had higher E/A in preoperation(0.9 ± 0.3 v 1.2 ± 0.5,P < 0.05)and lower S/D in postoperation(1.4 ± 0.2 v 1.2 ± 0.3,P < 0.05). Compared with patients in the E/A < 1 group, those in the E/A ≥ 1 group had lower S/D in preoperation and postoperation(1.3 ± 0.4 v 1.1 ± 0.4 and 1.4 ± 0.3 v 1.2 ± 0.3,P < 0.05) and lower AR in preoperation(18.0 ± 6.3 v 14.2 ± 4.1 cm/s,P < 0.05). The patients in the E/A < 1 group had higher proportion to need inotropic agents than those in the E/A≥1 group. Conclusion: It is TEE that can assess and distinguish heart systolic and diastolic function of the patients undergoing CABG surgery. The data suggest left ventricle diastolic dysfunction is prevalent in these patients. Heart systolic function improves promptly and significantly after revascularization, but diastolic function does not.