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Pump models assessed by transesophageal echocardiography during cardiopulmonary resuscitation 总被引:1,自引:0,他引:1
Themechanismofbloodflowduringclosed chestcardiopulmonaryresuscitation (CPR )inhumanbeingsremainscontroversialdespitethefactthatmodernCPRhasgainedwidespreaduseinclinicalpracticeformorethanfourdecades Twoprincipalandcompetinghypotheseshavebeenproposedtoex… 相似文献
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目的 对院内心脏骤停患者于心肺复苏期间行经食管超声心动图检查,以进一步探讨心肺复苏时的血液动力学机制.方法 对6例院内心脏骤停患者依照进一步心血管生命支持指南行心肺复苏术.于心肺复苏15 min内,在喉镜指引下,插入多平面食管超声探头,采用二维及脉冲波多普勒超声心动图技术,观察整个心肺复苏过程中二尖瓣、三尖瓣和主动脉瓣的运动状况,左室内径、胸主动脉内径的变化和二尖瓣、主动脉瓣的血流频谱.结果 所有的6例病人,胸按压时,二尖瓣和三尖瓣关闭,同时主动脉瓣开放,前向血流自心室进入体循环和肺循环;发生在胸按压时的主动脉瓣峰值前向血流速度为58.8±11.6?cm/s.而在按压放松时,主动脉瓣关闭伴房室瓣迅速开放,出现心室充盈,二尖瓣峰值前向血流速度为60.6±20.0?cm/s.有5例病人在按压期出现二尖瓣反流,提示存在着室至房的压力阶差.所有的6例病人于胸按压时出现左室内径减小和胸主动脉内径增加,表明直接的心室受压是前向血流产生的机制.结论 上述资料支持心泵理论是人类心肺复苏时产生前向血流的主导性机制. 相似文献
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Liu P Gao Y Fu X Lu J Zhou Y Wei X Li G Ding M Wu H Ye W Liu Y Li Z 《中华医学杂志(英文版)》2002,115(3):359-363
目的 对院内心脏骤停患者于心肺复苏期间行经食管超声心动图检查 ,以进一步探讨心肺复苏时的血液动力学机制。方法 对 6例院内心脏骤停患者依照进一步心血管生命支持指南行心肺复苏术。于心肺复苏 15min内 ,在喉镜指引下 ,插入多平面食管超声探头 ,采用二维及脉冲波多普勒超声心动图技术 ,观察整个心肺复苏过程中二尖瓣、三尖瓣和主动脉瓣的运动状况 ,左室内径、胸主动脉内径的变化和二尖瓣、主动脉瓣的血流频谱。结果 所有的 6例病人 ,胸按压时 ,二尖瓣和三尖瓣关闭 ,同时主动脉瓣开放 ,前向血流自心室进入体循环和肺循环 ;发生在胸按压时的主动脉瓣峰值前向血流速度为 5 8 8± 11 6cm/s。而在按压放松时 ,主动脉瓣关闭伴房室瓣迅速开放 ,出现心室充盈 ,二尖瓣峰值前向血流速度为 6 0 6± 2 0 0cm/s。有 5例病人在按压期出现二尖瓣反流 ,提示存在着室至房的压力阶差。所有的 6例病人于胸按压时出现左室内径减小和胸主动脉内径增加 ,表明直接的心室受压是前向血流产生的机制。结论 上述资料支持心泵理论是人类心肺复苏时产生前向血流的主导性机制。 相似文献
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目的探讨经食管超声心动图(transesophageal echocardiography,TEE)在先天性心脏病(congenital heart disease,CHD)外科矫治手术和内科介入封堵术前及术中的应用价值。方法对113名CHD患者行术前常规经胸超声心动图(transthoracic echocardiography,TTE)和术前TEE检查,应用术中TEE(intra-operative TEE,ITEE)即时评价疗效,并就术中所见与术前TTE和TEE检查结果相对照,同时观察外科手术与介入治疗术中室间隔运动幅度的变化,对室间隔运动异常的患者进行术后随访,评价不同创伤性治疗方式对室间隔心肌损伤的程度。结果 TEE术前诊断准确率为98.23%,明显高于TTE(92.04%)。ITEE发现术中残余问题18例(15.93%),其中5例(27.78%)立即予以处理。ITEE发现修补手术室间隔运动幅度出现异常率为81.54%(53/65),介入封堵组未见室间隔运动异常病例,两种治疗方式致室壁运动异常有统计学意义。本组TEE插入无严重并发症发生。结论 TEE能提高CHD创伤性治疗的安全性和疗效,有效指导CHD创伤性治疗。 相似文献
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Shen-Kou Tsai 《Journal of the Chinese Medical Association》2013,76(12):661-672
Transesophageal echocardiography (TEE) is not only an invaluable diagnostic tool for cardiac patients, but also is essential for cardiac monitoring in critically ill patients in cardiac and non-cardiac surgery settings and in the differential diagnosis of unexplained hemodynamic collapse. The advantage of TEE over transthoracic echocardiography (TTE) is usually clearer images, especially when viewing structures that are difficult to see transthoracically. TEE is essential in monitoring adult and congenital heart surgery perioperatively. The adequacy of the repair can be ensured immediately through a review of TEE images directly after surgery. Although TEE is considered to be relatively safe and noninvasive, TEE-associated complications, such as esophageal laceration, must be taken seriously. Recently, real-time three-dimensional (3D) TEE imaging has played an important role defining valvular and congenital abnormalities and aiding in operative and percutaneous repair. 相似文献
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目的:应用TEE及经胸壁超声心动图(TTE)在探查心脏及主动脉弓潜在性栓塞源(PES)的相对价值,并进一步了解主动脉弓动脉粥样硬化(AAA)在缺血性中风中的作用。方法:所有患进行了TTE及TEE检查;同时对所有患进行了颈动脉实时超声,TCD,CT检查,部分患进行了DSA及MRI等检查。AAA分为三级:轻度、中度、重度或活动性动脉粥样硬化斑声。结果:①TTE不能发现主动脉弓病变;②在TEE检查中:31例(63%)在主动脉弓发现有动脉粥样硬化性病变。其中7例(14.1%)呈轻度病理性改变,9例(18.4%)呈中度病理性改变,15例(30.6%)呈重度病理性改变,该15例中11例患无明显的颈内动脉及心脏疾患,其主动脉弓斑块可能是其脑栓塞的主要原因;两比较,TEE对心脏及主动脉弓的PES的发现率为48.98%,而TTE仅为18.4%;33例患伴有颈内动脉动脉粥样硬化(ICAA)改变;9例患伴有心脏疾病;高龄及ICAA组AAA的发病率明显增高。结论:TEE是目前探查主动脉弓及心脏PES的一个较好的检查手段。主动脉弓动脉粥样硬化在缺血性中风中非常常见,AAA在缺血性脑血管病的病因学中是一个应该值得重视的潜在栓塞源。 相似文献
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Shen-Kou Tsai Jeng Wei Ming C. Hsiung Ching-Huei Ou Chung-Yi Chang Yi-Cheng Chuang Kuo-Chen Lee Yi-Pen Chou 《Journal of the Chinese Medical Association》2013,76(7):372-377
BackgroundTwo-dimensional transesophageal echocardiography (2D TEE) Doppler color flow imaging is the gold standard for assessing the severity of mitral regurgitation (MR). Severe MR with very eccentric jet may involve more than one mitral leaflet lesion and can be missed by 2D TEE. The purpose of this study was to assess the usefulness and the incremental value of real-time three-dimensional (RT 3D) TEE over 2D TEE findings in the evaluation of patients suffering eccentric MR with more than one mitral leaflet lesion.MethodsIntraoperative 2D TEE and RT 3D TEE examinations were performed on 168 patients with Carpenter II MR who underwent surgery. MR was defined as either central, free-standing eccentric jet or very eccentric jet. 2D TEE and RT 3D TEE finding were compared with surgical findings.ResultsOf these 168 MR patients, 25 patients (14.9%) had central jets and 143 patients (85.1%) had eccentric jets. Among 143 patients with eccentric jets, 47 patients (32.9%) had free-standing eccentric MR jets, and 96 (67.1%) patients had very eccentric jets. 3D TEE diagnosed the severity and location of MR lesions correctly in all patients; this was not the case with 2D TEE, which had significant diagnostic misses in nine patients (9.4%, p < 0.001) having MR with very eccentric jets. These nine patients had lesions on both mitral leaflets, which were missed during 2D TEE examination owing to the highly turbulent flows produced by very eccentric jets from one mitral leaflet lesion and impinging the opposite mitral leaflet lesion.ConclusionThe severity of MR with very eccentric jet was more accurately and comprehensively assessed by 3D TEE than by 2D TEE. Therefore, intraoperative RT 3D TEE provides incremental information that is generally superior to 2D TEE in patients with complex MR due to very eccentric jets. 相似文献
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Background Live three-dimensional transesophageal echocardiography (live-3D-TEE) is a new technique, but its clinical value is unclear at present. This study aimed to investigate the feasibility, imaging quality and accuracy of live-3D-TEE for assessing mitral valve morphology to determine if live-3D-TEE has important value in mitral valve surgery.
Methods Twenty-four patients with mitral valve disease (mean age (47.1±11.6) years, mean weight (64.7±10.5) kg) underwent live-3D-TEE and two dimensional transesophageal echocardiography (2D-TEE) before and after mitral valve surgery. Sensitivity, specificity, and total consistency rates of live-3D-TEE for diagnosing ruptured chordae were calculated and compared to surgeon's findings. We also compared the diagnostic accuracy of mitral valve disease between live-3D-TEE and 2D-TEE.
Results Live-3D-TEE allowed visualization of the anatomic structure of the heart online and clearly identified the valvular apparatus and their defects. Sensitivity and specificity for the detection of ruptured chordae by live-3D-TEE were 87.5% and 100% respectively, and the total consistency rate was 95.8%. Additional defects not diagnosted by 2D-TEE were found in three cases (12.5%) preoperatively by live-3D-TEE. Live-3D-TEE could evaluate the function of prosthetic or native valves immediately after operation. One case was re-repaired (4.2%) using guidance by live-3D-TEE.
Conclusion Live-3D-TEE enabled evaluation of mitral valve function and provided adequate valuable information before and after mitral valve surgery. We conclude that live-3D-TEE can play an important role in mitral valve surgery. 相似文献
Methods Twenty-four patients with mitral valve disease (mean age (47.1±11.6) years, mean weight (64.7±10.5) kg) underwent live-3D-TEE and two dimensional transesophageal echocardiography (2D-TEE) before and after mitral valve surgery. Sensitivity, specificity, and total consistency rates of live-3D-TEE for diagnosing ruptured chordae were calculated and compared to surgeon's findings. We also compared the diagnostic accuracy of mitral valve disease between live-3D-TEE and 2D-TEE.
Results Live-3D-TEE allowed visualization of the anatomic structure of the heart online and clearly identified the valvular apparatus and their defects. Sensitivity and specificity for the detection of ruptured chordae by live-3D-TEE were 87.5% and 100% respectively, and the total consistency rate was 95.8%. Additional defects not diagnosted by 2D-TEE were found in three cases (12.5%) preoperatively by live-3D-TEE. Live-3D-TEE could evaluate the function of prosthetic or native valves immediately after operation. One case was re-repaired (4.2%) using guidance by live-3D-TEE.
Conclusion Live-3D-TEE enabled evaluation of mitral valve function and provided adequate valuable information before and after mitral valve surgery. We conclude that live-3D-TEE can play an important role in mitral valve surgery. 相似文献
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《中国现代医生》2021,59(7):119-122+封三
目的探讨术中经食管超声心动图(TEE)在心脏外科手术中的应用价值。方法回顾性分析2017年1月至2020年6月在我院心外科手术并行术中TEE监测的143例患者,比较术前经胸超声心动图(TTE)检查与TTE联合TEE的诊断符合率,总结术前TEE的补充诊断及对术式的影响,总结术后即刻TEE检查的异常结果及外科处理。结果与手术结果对比,术前TTE检查,完全符合率为86.71%,TTE联合TEE诊断后,完全符合率提高到99.12%,差异有统计学意义(P0.05);术前TEE检查补充诊断16例,包括瓣膜赘生物4例,卵圆孔未闭4例,房间隔缺损2例,房间隔膨胀瘤+卵圆孔未闭1例,右冠窦瘤破入右室1例,左心耳血栓+二尖瓣机械瓣瓣架血栓1例,二尖瓣生物瓣瓣周漏1例,左心耳血栓1例,左房多发肿瘤1例,其中8例改变手术方案;术后即刻TEE评估手术效果,11例再次进行外科干预处理。结论术中TEE既能在术前补充诊断,提高诊断符合率,影响手术方案的决策,又能在术后即刻评估手术效果,及时发现异常并指导外科补救,值得临床推广应用。 相似文献
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Summary It is difficult for conventional transthoracic echocardiography (TTE), by which precise and accurate images of interatrial
septum (IAS) can not be acquired, to diagnose patent foramen ovale (PFO) clearly. To evaluate the diagnostic value of biplanar
transesophageal echocardiography (TEE) for PFO, TTE and biplanar TEE were performed simultaneously in 270 patients. It was
found that in 7 patients patent foramen ovale was detected only through longitudinal planes of biplanar TEE. IAS, which consists
of primitive septum and membrane of fossa ovalis, can be directly visualized by two-dimensional images of TEE; in patients
with PFO, a dull color flow, which shunts from the right atria to the left atria through the gap between primitive septum
and fossa ovalis, can be detected by color Doppler flow images. Furthermore, some right-to-left shunting microbubbles through
the valve of patent fossa ovalis can be discovered by cardiac acoustic contrast echocardiography. In conclusion, biplanar
TEE combined with color Doppler image and cardiac acoustic contrast facilitates a definite diagnosis of patent foramen ovale
as the excellent anatomic images of IAS can be obtained from multiple views under this kind of performance. 相似文献
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目的 探讨经食管实时三维超声心动图(RT3D-TEE)在二尖瓣成形术中的应用价值。方法 18 例
拟行二尖瓣成形术的二尖瓣脱垂患者,术前及术后即刻均接受RT3D-TEE 检查。术前观察二尖瓣脱垂的三
维特征及小叶区域,与外科术中所见对照;术后即刻评估二尖瓣成形的手术效果,比较手术前后二尖瓣的对合
高度、瓣环周长和反流面积。结果 RT3D-TEE 显示二尖瓣脱垂的三维图像与外科视野所见高度一致,术前诊
断脱垂小叶的敏感性、特异性分别为96.00%、100.00%。18 例患者中有2 例转行二尖瓣置换术,其余16 例
成功完成二尖瓣成形术。RT3D-TEE 观察术后二尖瓣叶及人工瓣环的形态良好,二尖瓣反流程度明显改善。
二尖瓣的对合高度较术前增加,瓣环周长、反流面积较术前减少,差异有统计学意义(t =-13.556,37.789 和
20.847,均P =0.000)。结论 RT3D-TEE 能清晰显示二尖瓣的三维形态,术前准确诊断脱垂小叶及术后即刻评
估手术效果,在二尖瓣成形术中发挥重要的作用。 相似文献
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Wang Xin-fang Li Zhi-an Deng You-bin Wang Jia-en Wu Ying Yang Ya 《华中科技大学学报(医学英德文版)》1991,11(2):93-100
Summary In order to recognize correctly the images of transesophageal echocardiography (TEE), in 410 subjects TEE was performed with
uniplane or biplane transducer, and in 7 corpses the cardiac anatomic segments were observed, at various levels and in different
directions. 9 transverse and 6 longitudinal views were compared with the corresponding cardiac anatomic segments. Based on
this study, the authors reported the levels of segments, insertion depth, anatomic structure identification, image characteristics
and clinical application of TEE, and the advantages of biplane TEE are discussed. 相似文献
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超声检测胸主动脉粥样硬化的临床意义 总被引:1,自引:0,他引:1
目的:探讨胸主动脉粥样硬化的临床意义。方法:应用经食管超声心动图检测41例正常人、42例高血压、49例冠心病和31例脑梗死患者的胸主动脉粥样斑块的形成,测量胸主动脉内径及内膜中层厚度(IMT)。结果:与对照组比较,其他3组胸主动脉内径扩大,IMT增厚;胸主动脉粥样斑块的检出率由高到低依次为脑梗死组>冠心病组>高血压病组;胸主动脉粥样斑块诊断冠心病的敏感性为63.27%,特异性为97.56%。结论:胸主动脉内径扩大、IMT增厚是高血压、动脉粥样硬化的一种血管重构现象;胸主动脉粥样斑块是预测冠心病的有用指标。 相似文献
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AssessmentofRightCoronaryArteryFistulaby MultiplaneTransesophagealEchocardiographyYANGYa(杨娅);WANGXinfang(王新房);LIZhian(李治安)(De... 相似文献
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经食管超声对胸主动脉解剖与功能的研究 总被引:2,自引:0,他引:2
目的探讨国人胸主动脉解剖与功能特点及影响因素。方法应用多平面经食管超声技术,测量正常组134名和高血压病组42例受试者的胸主动脉舒张期内径(Dd)、收缩期内径(Ds)、Dd与Ds之差(ΔD)、内膜-中层厚度(IMT),计算PETERSON′S弹性指数(Ep)、YOUNG′S弹性指数(Es)、胸主动脉僵硬度(β)。结果正常组中不同年龄段各项测定值差异有显著意义,年龄与Dd、Ds、IMT、Ep、Es及β呈显著正相关。男女比较,男性Dd、Ds增大,IMT增厚。高血压病组与对照组比较,各测定值差异有显著意义(P<005~001)。结论年龄增大和高血压使胸主动脉内径增大,内膜增厚,顺应性下降,僵硬度增大,男性性别主要影响内径和内膜厚度。 相似文献