非体外循环冠状动脉搭桥术前后肺动脉楔嵌压的经食管超声研究

目的应用经食管多普勒超声心动图(TEE)检测非体外循环冠状动脉搭桥术(OPCAB)前后肺动脉楔嵌压(PCWP)的变化.方法应用TEE检测46例行OPCAB前后二尖瓣血流频谱(MVF)和肺静脉血流频谱(PVF),同步应用心导管技术检测PCWP.对所测量指标进行术前术后对比分析,并将PCWP与TEE所测指标进行相关分析.结果 OPCAB前后能反映左室收缩舒张功能的TEE测量指标和PCWP有明显改善;MVF与PVF的各指标与PCWP有相关性(r＝0.30～0.76,P＜0.01～0.05),其中反向A波峰值血流速度(PVa)、反向A波速度时间积分(VTIpva)及MVF与PVF相结合的指标Tpvadt-mvadt、Tpvat-mvat相关性最好(r＝0.75～0.89,P＜0.001).结论 TEE检测PVF和MVF所得各指标可用来估算PCWP,对OPCAB疗效进行评价;OPCAB术后即刻左室功能有改善.

Changes of Pulmonary Capillary Wedge Pressure in Patients After Off-pump Coronary Artery Bypass Using Transesophageal Echocardiography and Cardiac Catheterization

Objective To investigate the changes of pulmonary capillary wedge pressure(PCWP) between before and after off pump coronary artery bypass(OPCAB) using transesophageal echocardiography(TEE) Methods Mitral valve flow(MVF) and pulmonary veinous flow(PVF) were measured in 46 patients pre and post OPCAB using TEE and PCWP were detected by cardiac catheter The correlations between the indices derived from TEE and catheterization measured PCWP and the differences between pre and post OPCAB were studied Results There were obvious differences in the indices derived from TEE and PCWP which could reflect the left ventricular function The indices measured in PVF and MVF highly correlated with PCWP( r =0 30-0 76 P <0 01-0 05)among which PVa,VTIpva of PVF and Tpvadt mvadt,Tpvat mvat detected in combined PVF and MVF were the best ones( r =0 75 0 89, P <0 001) Conclusions The indices derived from MVF and PVF measured by TEE can be used to calculate PCWP simply and noninvasively and to assess OPCAB efficiently The left ventricular function has been significantly improved immediately after OPCAB