超声心动图对重症监护室患者管理重要性的研究

Impact of echocardiography on patient management in the intensive care unit

目的超声心动图对重症监护室（intensive care unit，ICU）患者的管理有着重要的作用，研究分析由具备基本心脏超声检查能力的ICU医师完成的超声检查对ICU患者管理的意义。方法采用回顾性临床观察研究的方法，纳入并记录2009年8月-2010年5月本院ICU中行经胸超声心动图（trans-thoracic echocardiogram，TrE）或经食管超声心动图（transesophageal echocardiogram，TEE）超声心动图检查的患者的基本信息，所患疾病，超声检查指征，阳性发现及对原有诊疗的改变。结果共82例ICU患者行超声检查142次，其中包括各种原因引起的感染性休克43例，失血性休克8例，及急性呼吸窘迫综合征31例，其中TTE86次，TEE56次。超声改变了54例（66％）患者的治疗策略，其中包括调整血管活性药物及容量治疗策略，及时外科干预及有创治疗或检查等。结论超声心动图对指导ICU患者的监测及治疗有着重要的意义，由ICU医师实施超声检查是可行的。超声在ICU中最主要的应用于评价血流动力学指标，心室功能及容量情况，同时其也能对一些ICU中常见严重并发症做出及时正确的诊断。

Objective Echocardiography has been shown to play an important role in management of critically ill patient. We then present a study of the impact of echocardiography done by well trained internist on management of patients in intensive care unit（ICU）. Methods In this retrospective clinical study, both trans-thoracic（TTE） and trans-esophageal echocardiogram （TEE）, performed on our ICU from August 2009 to May 2010. We recorded patient characteristics, indication for the echocardiogram, complication of TEE and any change in management that occurred as a result of the exam. Results 142 echocardiograms were performed in 82 patients, including 86 TIEs and 56 TEEs. Indications for echo include hemodynamic instability （76%）, suspected cardiac effusion （7%）, pulmonary embolism （5%）, infectious endocarditis （3%）, refractory hypoxia （2%） and atrial fibrillation （5%）. Management was changed directly as a result of echocardiogram exam in 66% of studies. Changes included change in inotrope or drug therapy, fluid administration and surgical consultation. Conclusion Echocardiography may have a significant impact on the management of patients in the general ICU.