TEE测量的门静脉时间平均峰值流速和门静脉血流量与体外循环时的灌注量之间的关系探讨

The correlation between the mean peak flow rate of portal vein time and portal blood flow and perfusion during extracorporeal circulation as measured by TEE

目的:评估食管超声心动图(TEE)在成人体外循环(ECC)下心内直视手术中实时监测肝脏门静脉血流的可行性。探讨TEE测量的门静脉时间平均峰值流速和门静脉血流量与体外循环时的灌注量之间的相关性。方法:选取2022年8月-2023年5月遵义医科大学附属医院行ECC下心内直视手术患者61例,手术中利用TEE监测心脏的同时测量门静脉内径和时间平均峰值流速(TAPV)并计算出门静脉血流量(PVBF)。记录体外循环参数、门静脉血流动力学指标。分析体外灌注量(VPF)与PVBF、平均动脉压(MAP)与PVBF的关系。结果:符合纳入标准并成功放入食管超声的患者中有58例患者获得满意的门静脉右支主干声像图,3例患者未能显示出门静脉,TEE显示门静脉成功率95.1%。ECC后患者循环稳定时门静脉搏动指数(PI)、阻力指数(RI)均较ECC前明显降低、PVBF较ECC前明显增高。体外灌注期间TAPV与VPF、PVBF与VPF均呈正相关(P<0.05),TAPV与MAP、PVBF与MAP均呈负相关(P<0.05)。结论:TEE可以作为一种ECC中实时动态监测门静脉血流的有效工具;成人ECC下心内直视手术体外灌注期间,ECC灌注量是决定门静脉血流灌注的主要因素。

Objective To evaluate the real-time monitoring of portal vein blood flow in the liver by trans esophageal echocardiography(TEE)during open-heart surgery under extracorporeal circulation(ECC)in adults of feasibility.To investigate the correlation between the mean peak flow rate of portal vein time and portal blood flow measured by TEE and perfusion during cardiopulmonary bypass.Methods From August 2022 to May 2023,61 patients undergoing open-heart surgery under ECC were selected from the Affiliated Hospital of Zunyi Medical University,and TEE was used to monitor the heart during the operation measure portal vein inner diameter and time-averaged peak velocity(TAPV)and calculate portal vein blood flow(PVBF).Extracorporeal circulation parameters,portal blood flow force were recorded Academic indicators.To analyze in vitro perfusion volume(VPF)versus PVBF and mean arterial pressure(MAP)versus PVBF.Results Met inclusion criteria and successfully placed in food Fifty-eight patients with ductal ultrasound obtained satisfactory sonogram of the right portal trunk,3 failed to show the portal vein,and TEE showed portal vein success 95.1%.When the circulation is stable after ECC,the portal pulse index(PI)and resistance index(RI)are significantly lower than before ECC,and PVBF is significantly higher than before ECC High.During in vitro perfusion,TAPV was positively correlated with VPF,PVBF and VPF(P<0.05),and TAPV was negatively correlated with MAP and PVBF with MAP(P<0.05).Conclusions TEE can be used as an effective tool for real-time dynamic monitoring of portal blood flow in ECC.Outside the scope of open-heart surgery under ECC in adults During perfusion,ECC perfusion is a major factor in determining portal blood perfusion.