经食管超声心动图在肺移植术中的作用

目的 探讨术中经食管超声心动图(TEE)在肺移植术中的应用价值.方法 2005年8月至2009年8月,19例平均年龄(48.35±13.04)岁的肺疾病晚期病人行肺移植手术.于肺移植术前麻醉后送入TEE探头,检测左、右肺静脉开口和肺动脉血流速度,右室壁运动,左、右心室容积,右室射血分数.观察房间隔有无交通.肺移植术中分别于断肺后和供肺支气管、肺静脉、肺动脉全部吻合开放后连续观察上述指标.结果 19例中6例为序贯式双肺移植,13例单肺移植,其中左叶肺移植2例、右叶肺移植11例.术中阻断一侧被移植肺的动、静脉后,该侧肺动、静脉血流消失,右室容积轻度增大.供体肺与受体肺全部气管、肺静脉、肺动脉吻合完毕开放后,右室容积恢复.TEE依次检测肺静脉、肺动脉吻合口,吻合口流速均轻度增快.开放后发现1例右肺动脉血流速度显著增快,经重新吻合后血流速度降低,血氧分压恢复.术中发现3例卵圆孔未闭.结论 TEE在肺移植术中监测肺动脉和肺静脉血管吻合口直径和血流速度,检测右心功能,对并发症的预测等起重要作用.

Abstract：

Objective To investigate the clinical value of transesophageal echocardiography during the lung transplanta tion. Methods From August 2005 to August 2009, 19 patients with advanced lung diseases received lung transplantation.The average age was(48.35±13.04) years. The echocardiographic probe was placed in patient's esophagus before surgery.The left and right pulmonary venous openings, artery blood flow velocity, right ventricular wall motion, left and right ventricular volume, right ventricular ejection fraction were recorded at different time intervals during lung transplantation, especially at the break and after completion of bronchus, pulmonary veins, and pulmonary artery anastomosis. Results The procedure included sequential-type lung transplantation in 6 cases and single lung transplantation in 13. The blood flow disappeared when blocking pulmonary artery and vein and right ventricular volume increased slightly. The right ventricular volume restored after completion of trachea, pulmonary veins, pulmonary artery anastomosis. TEE detected that the blood flow velocity of pulmonary veins, pulmonay artery anastomosis increased slightly. In 1 case the opening of the right pulmonsry artery blood flow velocity increased significantly and blood flow velocity decresed and blood oxygen partial pressure resumed after re-anastomosis of pulmonary artery. Conclusion TEE play an important role in monitoring pulmonary artery and vein anastomosis diameter and blood flow velocity and right ventricular function and predicting complications during lung transplantation.

Evaluate of transesophageal echocardiography during lung transplantation

Objective To investigate the clinical value of transesophageal echocardiography during the lung transplanta tion. Methods From August 2005 to August 2009, 19 patients with advanced lung diseases received lung transplantation.The average age was(48.35±13.04) years. The echocardiographic probe was placed in patient's esophagus before surgery.The left and right pulmonary venous openings, artery blood flow velocity, right ventricular wall motion, left and right ventricular volume, right ventricular ejection fraction were recorded at different time intervals during lung transplantation, especially at the break and after completion of bronchus, pulmonary veins, and pulmonary artery anastomosis. Results The procedure included sequential-type lung transplantation in 6 cases and single lung transplantation in 13. The blood flow disappeared when blocking pulmonary artery and vein and right ventricular volume increased slightly. The right ventricular volume restored after completion of trachea, pulmonary veins, pulmonary artery anastomosis. TEE detected that the blood flow velocity of pulmonary veins, pulmonay artery anastomosis increased slightly. In 1 case the opening of the right pulmonsry artery blood flow velocity increased significantly and blood flow velocity decresed and blood oxygen partial pressure resumed after re-anastomosis of pulmonary artery. Conclusion TEE play an important role in monitoring pulmonary artery and vein anastomosis diameter and blood flow velocity and right ventricular function and predicting complications during lung transplantation.