拟行神经外科坐位手术患者术前经食管超声心动图检查的应用体会

Preoperative application of transesophageal echocardiography in patients undergoing sitting-position neurosurgery

目的探讨经食管超声心动图(TEE)在拟行神经外科坐位肿瘤切除术患者术前应用中的意义。方法 2010年7月至2013年5月,首都医科大学宣武医院神经外科住院拟行听神经瘤及脑膜瘤切除术患者33例。所有患者均于术前行经胸超声心动图(TTE)及TEE结合右心声学造影检查,观察卵圆孔未闭(PFO)的发生情况。患者行右心房声学造影检查时,左心房内一个切面同时出现3个气泡定义为阳性,即PFO。术后随访脑栓塞情况。结果 (1)所有33例患者中有22例(66.7%)检出PFO;(2)TTE检查:仅1例(3.0%)患者检出PFO;(3)TEE检查:20例(60.6%)患者检出PFO;(4)TEE结合右心声学造影:共有22例(66.7%)患者可见心房水平的右向左分流征;(5)共7例患者行坐位手术,另26例患者行侧卧位手术。无1例患者术后出现脑栓塞。结论合并PFO是神经外科坐位肿瘤切除术的绝对禁忌证。术前TEE结合右心声学造影检查可明确检出PFO,对于及时调整手术方式,避免坐位手术可能出现的空气栓塞有决定性作用,应常规应用。

Objective To evaluate the efficacy of preoperative application of transesophageal echocardiography （TEE） in patients undergoing sitting-position neurosurgery. Methods This study involved 33 acoustic neuroma patients who were referred to neurosurgery. Transthoracic echocardiography, transesophageal eehocardiography and right heart contrast echocardiography were performed preoperatively to identify patent foramem ovale （PFO） , a contraindication for sitting-position procedure. The contrast study was considered positive if ≥ 3 microbubbles appeared in the left atrium. Results （ 1 ） Of the 33 acoustic neuroma patients, 22 （66. 7% ） had PFO. （2） Only 1 PFO （3.0%） was detected by TTE. （3） Twenty PFO patient （60. 6% ） were confirmed by TEE. （4） When TEE plus right heart contrast echocardiography was utilized, PFO was identified in 22 patients （66. 7% ）. （5） According to echo exam, 7 patients underwent sitting-position procedure and others had lying-position procedure performed. No cerebral embolism occurred during or after the procedure.. Conclusions TEE combined right heart contrast echocardiography is more sensitive for preoperatively detecting PFO, and which is necessary to the sittingposition neurosurgery.