经食管超声心动图在心脏手术麻醉中的应用

The application of transesophageal echocardiography to patients undergoing cardiac surgery

目的:评估经食管超声心动图(TEE)在心脏手术麻醉中的应用价值。方法:通过对4年来131例心脏手术病人麻醉中TEE监测,对术中常规排气病人,体外停机前后气体出现情况和其中38例风心病二尖瓣置换病人换瓣前后瓣膜返流等进行对比观察,气体量和返流量根据TEE所见分别分为4级(0～3)和5级(0～4)。结果:发现38例风心病二尖瓣置换病人中,35例(90%)残余返流量0级,术后平均返流量0.5±0.2,比术前平均返流量3.4±0.6明显减少(PP<0.01);2例(5%)二尖瓣置换术后病人仍有较大返流,立即进行了修补,术后好转;体外停机前后131例病人中115例检出气体(88%),其中2例气体量3级。同时在5例(4%)病人中发现了术前其它检查未能发现的心脏问题,这帮助和改变了手术计划。结论:TEE在心脏手术麻醉中的应用,不但能立即评估术后瓣膜功能状况,监测左心气体,而且有助于规范手术计划。

Objective: To assess the value of transesophageal echocardiography (TEE) during cardiac surgery. Method: Intraoperative TEE was performed to record left atrial gas during and for 15 minutes after bypass in 131 pa tients and to evaluate mitral regurgitation after mitral replacement in 38 patients. The degrees of the gas and mitral re gurgitation by TEE was visually quantified on a 4-point scale(0 to 3) and a 5-point scale(0 to 4), respectively. Result: The left atrial gas was detected in 115(88%)patients, two of which with positive echograms(gas grade=3). There was significant improvement in the mean mitral regurgitation grade after mitral replacement (3.4±0.6 to 0.5±0.2, P< 0.01). Excellent results after replacement with the residual mitral regurgiration at 0 grade were observed in 90% of patients. Significant residual mitral regurgitaton(grade 3)that necessitated immediately further surgery was identified in 2 patients (5%). Prebypass imaging yielded unsuspected finding that either assisted or changed the planned opera tion in 5(4%)patients. Conclusion: Intraoperative transesophageal echocardiography is useful in assessing immediate operative results, identifying retained air and formulating the surgical plan.