经胸心脏超声在危重症病人血流动力学监测中的应用进展

The application progress of h-TEE in hemodynamic monitoring of critically Ⅲ patients

危重症病人往往合并血流动力学不稳定,并且可危及病人生命,而对于此类病人血流动力学监测尤为重要,通常会使用肺动脉漂浮导管、脉波指示剂连续心排血量监测(PICCO)等传统血流动力学手段进行监测,而这些监测手段有局限性,床旁心脏超声作为最直观的监测,可以从图像中得出最直接的病理原因,经胸心脏超声(TTE)因其无创的优势被广泛用于重症病人的监测,但因受机械通气等影响成像效果欠佳,经食管心脏超声(TEE)图像质量高于TTE,然而TEE受到需要专业技术人员操作、不能持续动态监测病人血流动力学变化等限制,使其在危重症病人中使用存在局限性。在此基础上更加适用于危重症病人的连续血流动力学监测技术经食管血流动力学心脏超声(h-TEE)应运而生,它具备了比传统TEE探头更小、更便于插入,可以保留在病人体内72 h的优点,可持续动态观察病人的心功能、容量状况,该研究就h-TEE的工作原理及操作方法、优点、应用现状、安全性及改进之处等方面进行综述。

Critically ill patients often associated with hemodynamic instability which may endanger the lives of patients.So the hemodynamic monitoring is particularly important for such patients.Normally,we would use some traditional hemodynamic monitoring methods,such as fiberoptic pulmonary artery catheter,PICCO and so on.But these methods have their own limitations.Bedside echocardiography is the most intuitive monitoring technology,which can exhibit the pathological causes from the image.Transthoracic echocardiography （TTE） is widely used in critical patients because of its non-invasive advantages but its imaging effect is poor due to the influence of mechanical ventilation.The image quality of Transesophageal echocardiacgraphy （TEE） is higher than TTE.However,professional technical personnel is needed and hemodynamic changes cannot be sustained dynamically monitored for TEE which limited its use in critically ill patients.On this basis,was developed,which is more suitable for the continuous hemodynamic monitoring of critically ill patients.Compared to conventional TEE,h-TEE has a smaller transducer which makes it easier to insert,it can retain in a patient for 72 hours,which ensures sustainable observing of dynamic cardiac function and capacity situation in patients.This article reviewed the working principle,operation method,advantages,application status and safety improvements of h-TEE.