经食管超声心动图检测肺移植术中肺血管切面的应用价值

Detection of pulmonary vascular by transesophageal echocardiography during lung transplantation

目的 探讨术中经食管超声心动图（TEE）观察肺血管新的解剖切面图及其在肺移植术中的应用价值.方法 因肺部疾病晚期呼吸衰竭行肺移植术患者17例.于肺移植术前麻醉后送入TEE探头,分别于肺移植术中,断肺前后和供肺支气管、肺静脉、肺动脉全部吻合后连续观察,重点观察左、右肺静脉开口和左、右肺动脉分支,测量肺动脉主干及分支内径、血流速度.结果 17例肺移植患者TEE均获左、右肺动脉及肺静脉图像.术前TEE检测肺动脉分支血流速度正常,平均65 cm/s.断肺侧肺动、静脉血流消失.供体肺与受体肺全部气管、肺静脉、肺动脉吻合完毕开放后,TEE依次检测肺静、动脉吻合口,除1例肺静脉吻合口流速增快外,所有肺静脉吻合口流速和肺动脉分支吻合口流速均较移植前轻度增快（肺动脉分支平均160 cm/s,肺静脉平均149 cm/s）.结论 TEE在肺移植术前后可监测肺动脉分支和肺静脉血管直径和血流速度,检测右心功能.左、右肺动脉分支和肺静脉分支切面在观察肺移植前后肺血流中有非常关键的作用.

Objective To detect the new views for pulmonary vascular by transesophageal echocardiography（TEE） during lung transplantation.Methods Seventeen cases with respiratory failure underwent lung transplantation.A series of scans were detected by TEE during preoperative anesthesia, preand pro-pulmonary vascular occlusion and pro-donor lung, and bronchus, pulmonary veins, pulmonary artery anastomoses.Left and right lung veins open and left and right pulmonary artery branch were key to observed.Pulmonary artery trunk and branch diameter, velocity of blood flow were measured.Results All left and right pulmonary artery,pulmonary vein images were given by TEE.TEE detected the normal blood flow velocity of pulmonary artery branches during pre-operation,average of 65 cm/s.After clipping the side of the pulmonary artery, the lateral pulmonary blood flow disappeared.TEE detected pulmonary veins,pulmonary artery anastomoses pro-operation.Except for 1 case of anastomotic pulmonary vein flow velocity increased,all the pulmonary vein and pulmonary artery branch anastomoses flow velocity increased slightly faster than those before transplantation （mean pulmonary artery branch of 160 cm/s, the average pulmonary vein 149 cm/s）.Conclusions TEE can monitor diameter and flow velocity of pulmonary artery branch and pulmonary vein during lung transplantation,and can detect the rightventricular function.The views of left and right branch pulmonary artery and pulmonary vein branches play an important role during lung transplantation.