食管超声心动图在重危心脏病人诊断治疗中的价值

Role of Transesophageal Echocardiography in Critically Ill Patients in Intensive Care Units

目的 为评价食管超声心动图 (TEE)在重危心脏病人诊断治疗中的价值 ,对 3 7例收住监护病房的重症心血管病人进行了经胸超声心动图 (TTE)和TEE检查 ,其中男 2 5例 ,女 1 2例 ,平均年龄57( 1 9～ 85)岁。入选对象包括怀疑夹层动脉瘤 2 3例、心脏瓣膜功能异常 9例、感染性心内膜炎 3例 ,心内分流 2例。结果 所有病人均可耐受TEE检查 ,无并发症发生 ,TEE较TTE可提供更高的阳性诊断结果 ,阳性率分别为 65 0 %和 3 8 0 % ,在怀疑夹层动脉瘤者中 ,TEE检出夹层撕裂膜 1 4例 ;而TTE仅检出 7例 ,且图象欠清 ,检出部位有限。在 4例人工机械瓣膜功能异常者中 ,TEE发现瓣膜部位血栓形成 3例。结论 在对心脏大血管疾病的诊断中 ,TEE阳性诊断率高于TTE ,尤其在怀疑夹层动脉瘤及人工机械瓣膜病变时 ,应行TEE检查。即使在重危病人 ,TEE也是一种安全有效的诊断手段。

Objective To determine the role and incremental value of Transesophageal echocardiography (TEE) in critically ill patients in intensive care units (ICU) Methods We evaluated 37 consecutive critically ill patients (male 25,female 12) with a mean age of 57 years (19~85) Bedside transthoracic echocardiography (TTE) and TEE were both performed in the ICU for suspected aortic dissection (23),valvular dysfunction (9),endocarditis (3),and intracardiac shunt (2) Results Intubation for TEE was performed successfully following sedation without any complication TEE provided additional clinically relevant information compared to TTE (65% vs 38%) Among the patients evaluated for suspected aortic dissection,an intimal flap was detected in 14 patients by TEE compared to 7 patients with TTE Among patients with suspected prosthetic valve thrombosis,thrombus was demonstrated only by TEE in 3 cases Conclusion TEE is safe and can provide incremental value compared to TTE in a critically ill population studied in ICU,especially in patients with suspected aortic dissection or prosthetic valve dysfunction