经食管超声心动图监测腹腔镜手术患者肾血流量的准确性

Renal blood flow assessed by transesophageal echocardiography during laparoscopic cholecystectomy

目的探讨CO2气腹时经食管超声心动图（TEE）监测肾血流量的准确性。方法择期行腹腔镜胆囊切除术（LC）患者35例,术中采用TEE分别于气腹前、气腹1、5、10、15、20、30min、气腹停止后1、5min测定左肾动脉主干内径（RAD）,记录左肾动脉主干血流速度时间积分（VTI）,计算左肾血流量（LRBF）及左肾血流灌注阻力（LRPR）,由一位专门人员在上述各时间点进行超声图像质量评分。3个月后随机抽取10例患者,由同一人员和不同人员对超声图像进行重复测定,分析TEE测定的可重复性和一致性。结果气腹前肾超声图像满意率94%,与气腹前比较,气腹中各时间点超声图像质量评分差异无统计学意义（P〉0.05）,气腹中RAD、VTI和LRBF降低,LRPR升高（P〈0.05）,气腹停止后恢复（P〉0.05）。RAD和VTI偏差：同一人员分别为9.28%和5.61%,不同人员分别为8.71%和6.25%,两次重复测定RAD和VTI与第1次测定值的直线回归方程的回归系数分别为1.05、0.92,截距分别为31.4、47.3ml/min（P〈0.05）。结论TEE可准确地监测CO2气腹时肾血流量。

Objective To determine the accuracy of assessment of the renal blood flow by transesophageal echocardiography（TEE） during carbon dioxide pneumoperitoneum. Methods Left renal arterial diameter （RAD） and the Doppler velocity time integral （VTI） were measured by TEE in 35 patients undergoing elective laparoscopic cholecystectomy before peumoperitoneum （To, baseline）, at 1, 5, 10, 15, 20, 30 min of pneumoperitoneum and 1, 5 min after deflation. The left renal blood flow （LRBF） and the left renal blood perfusion resistance （LRPR） were calculated according to the following formulae： LRBF = 1/4π × RAD^2 × VTI × HR, LRPR = MAP/ LRBF.Three months later the TEE images were reviewed by the same and another research team member to check the reproductivity of the LRBF determined during operation. The quality of the TEE images was evaluated by an independent specialist. Results Before pneumoperitoneum 94% of the TEE images were rated as satisfactory. There was no significant difference in the quality of TEE images obtained before and during pneumoperitoneum. The variability between the RAD and VTI measured by TEE during and 3 months after operation was 9.28 % and 5.61% respectively by the same team member and 8.71% and 6.25 % respectively by another team member. The linear regression analysis of the LRBF showed that the slope and the intercept were 1.05 and 31.4 ml/min respectively by the same member and 0.92 and 47.3 ml/min respectively by another member. The LRBF was decreased during pneumoperitoneum and the left renal blood perfuse resistance was increased. Conclusion TEE can be used to monitor the changes in renal blood flow during CO2 pneumoperitoneum.