床旁超声在危重症心脏外科围手术期的应用

Application of the bedside ultrsound in the severe perioperative cadiac surgery patients

目的:观察床旁超声对心脏外科围手术期危重患者治疗决策的影响。方法:对183例心脏术后危重患者行床旁紧急超声检查,评估患者心腔的饱满程度、心肌收缩力、收缩协调性、心包有无积液及血栓压迫、瓣膜活动度、跨瓣膜血流速度等。对于术后出现低氧血症患者行胸腔及肺部超声检查,筛查患者有无胸腔积血、积液、肺不张、气胸等。对于术后出现无法控制的发热患者常规筛查瓣膜有无赘生物。结果:138例患者床旁超声检查后与常规临床判断及治疗决策一致,45例循环波动、低氧血症或少尿患者行超声检查后指导临床作出决定性、挽救性治疗决策。结论:对于心脏围手术期危重症患者及时行床旁重症超声检查可指导临床医生作出决策性治疗方案。

Objective：To observe the effect of the bedside ultrsound to the therapy in severe perioperative cadiac surgery patients.Methods：We performed bedside ultrosound on 183 cases of severe perioperative cadiac surgery patients to evaluate the volume of the ventricular,the myocardial contractility,the myocardial coordination,pericardial effusion,pericardial thrombosis,the valvular activity,and the blood flow velocity across the valve.For patients with hypoxemia we performed chest and lung ultrasound to check for pleural effusion,the blood in the chest,atelectasis,and pneumothorax.For fever patients we screened endocarditis.Results：One hundred and thirty-eight patients who performed bedside ultrosound were continued the clinical judgment and treatment decisions.Forty-five severe patients with circulation fluctuations,hypoxemia or oliguria we changed the clinical decision.Conclusion：We should make full use of the bedside ultrosound on the severe perioperative cadiac surgery patients which can help us decide the right treatment program.