术中经食管超声心动图引导和评价心血管外科手术

目的 探讨术中经食管超声心动图(IOTEE)在心血管外科手术治疗中的作用及对手术效果的评价。方法 以IOTEE监测心外科手术患者共591例，于体外循环(CPB)前后或非体外循环(Off Pump)状态下手术前后对心脏及大血管的结构和功能进行监测和评价。对部分患者帮助制定手术方式。结果 IOTEE在CPB或心脏手术前修正术前诊断23例，主要为瓣膜结构判断以及流出道狭窄等方面；IOTEE共干预手术60例次，其中决策性干预44例次，主要集中在瓣膜成形以及室间隔缺损修补、流出道疏通等；帮助修改手术方案31例次，主要为决定瓣膜成形或置换、是否采用Off Pump等。一般性干预主要是指导排气、术后判断心功能改变而使用对症药物等。结论 IOTEE可在CPB或心脏手术前修正术前诊断、帮助修改手术方案、术后判断手术效果及是否需再次转机、指导术后排气以及根据术后心功能指导用药等。IOTEE已成为心血管外科手术中一项重要的监测与评价手段。

Monitoring,Guidance and Evaluation of Intraoperative Echocardiography in Cardiac Surgery

Objective:To explore the monitoring,guidance and evaluative effect of intraoperative transesophageal echocardiography (IOTEE) in cardiac surgery.Methods:During 1 year from 2001 to 2002,a total of 591 patients underwent IOTEE monitoring,guidance and evaluation during receiving cardiovascular surgery (362 male and 229 female),with mean age of 40 years old (1~85 years).Among them,319 had valves repaired or replaced,107 received coronary artery bypass grafting,33 had great artery replaced,5 had cardiac tumor removed and 175 were congenital heart diseases,48 of which were with complicated cardiac structural anomalies.Siemens Acuson Aspen and 128XP color Doppler echo equipments with ominiplane or biplane transesophageal probe were used for intraoperative monitoring,guidance and evaluation.Results:No transesophageal ultrasound related complications occurred.Twenty-three patients had modified diagnosis or changed operative procedure due to new findings or informations before cardiopulmonary bypasses,mainly with valvular diseases or outflow tract stenosis.Sixty patients were guided with IOTEE,including 44 had second or third pump run for revising repair or modification after IOTEE evaluation due to inadequate procedures.Thirty-one cases had operative procedure modified under IOTEE guidance,mainly for deciding valvular repair or replacement,with cardiopulmonary bypass or with off pump.Other monitoring included surgical ventilation,wall motion or ventricular function assessment.Conclusions:IOTEE is a good method to monitor,guide and evaluate cardiac surgery for modifying preoperative diagnosis,operation procedure,outcome and another pump run needed to minimize second open chest operation.