食道超声心动图经二尖瓣和升主动脉测定二尖瓣置换术患者心脏指数的一致性

Agreement between cardiac index measured by transesophageal echocardiography through mitral valve and ascending aotra in patients undergoing mitral valve replacement

目的评价食道超声心动图（TEE）经二尖瓣（MV）和升主动脉（AA）测定二尖瓣置换术患者心脏指数（CI）的一致性。方法择期在CPB下行单纯二尖瓣置换术的患者16例，性别不限，年龄18～70岁，体重46～72kg，ASA分级Ⅱ级或Ⅲ级，术前NYHA心功能分级Ⅱ级或Ⅲ级。麻醉诱导及术中维持均采用全凭静脉麻醉。麻醉诱导气管插管后放置TEE探头，于CPB停止后15min（T1）、30min（T2）、60min（T3）时经MV和AA测定CI（CIMV、CIAA）。两种方法的一致性分析采用Bland—AhmanPLOT一致性检验。结果各时点CIMV均低于CIAA（P〈0．01）；一致性检验结果：CIMV为1．29—5．52L·min^-1·m^-2，平均（2．6±0．9）L·min^-1·m^-1，CIAA为2．7～8．8L·min^-1·m^-2，平均（4．9±1．7）L·min^-1·m^-2，平均偏差为-2．3L·min^-1·m^-2，95％一致性界限为-5．62～1．03L·min^-1·m^-2，r=-0．577，P〈0．01。结论采用TEE经MV和AA测定的cI具有较好的一致性，但CIAA明显高于CIMV，在临床上该结果的差异较大，两种测定CI的方法不能相互替代。

Objective To determine if the cardiac index （CI） measured by transesophageal echocardio- graphy （TEE） through the mitral valve （MV） agrees with that measured by transesophageal echocardiography through the ascending aorta （AA） .Methods Sixteen ASA Ⅱ orⅢ patients （NYHA Ⅱ or Ⅲ ）, aged 18-70 kg, weighing 46-72 kg, undergoing mitral valve replacement under cardiopulmonary bypass （CPB）, were studied. Total intravenous anesthesia was used for induction and maintenance of anesthesia. After tracheal intubation, the TEE probe was placed in the esophagus. CI was measured by transesophageal echocardiography through the MV （CIMV） and AA （ CIAA ） at 15, 30 and 60 min after termination of CPB and recorded. All the data were compared by Bland-Ahmau analysis. Results CIMV values were significantly lower at each time point than CIAA values （P 〈 0.01）. The results of Bland-Airman comparison： C/My 1.29-5.52 L·min^-1·m^-2, mean was （2.6 ± 0.9） L·min^-1·m^-2, and CIAA 2.7-8.8L·min^-1·m^-2, mean was （4.9 ± 1.7） L·min^-1·m^-2, bias was - 2.3 L·min^-1·m^-2 , and limit of agreement was - 5.62-1.03 L·min^-1·m^-2 resulting in r = - 0.577, P 〈 0.01. Conclusion CI values obtained through the MV agrees well with that measured through the AA using TEE in pa- tients undergoing mitral valve replacement, but CIAA values are significantly higher than CIMv values, there is a large difference between them for clinical use, and both methods for CI measurement cannot replace each other.