目的 探讨经食管超声心动图(esophageal echocardiography,TEE)指导体外循环(extracorporeal circulation,CPB)心脏手术后心内排气的应用价值。方法 选取2020-01至2021-12在解放军总医院第六医学中心行CPB心脏手术患者70例,随机分为观察组和对照组,每组35例。观察组采用TEE监测,对照组采用传统监测。记录两组心脏复跳时间,观察心内排气情况,记录不同时间点时平均动脉压(mean arterial pressure, MAP)及乳酸值。并对两组手术前后左室收缩末期内径(left ventricular end systolic diameter, LVESD)、左室舒张末期内径(left ventricular end diastolic diameter, LVEDD)、左室射血分数(left ventricular ejection fraction,LVEF)进行对比分析。结果 观察组患者心脏复跳时间[(25.12±2.13)min]明显短于对照组心脏复跳时间[(29.45±2.84)min],差异有统计学意义(t=7.2159,P＜0.05);心脏复跳后观察组存在不同程度左心气体,TEE指导后充分排气,无并发症;两组T1-T3时间MAP、T0-T4时间乳酸值对比,差异均有统计学意义(P＜0.05)。手术后观察组LVESD、LVEDD明显低于对照组, LVEF明显高于对照组,差异均有统计学意义(P＜0.05)。结论 TEE监测在CPB手术中可指导心内排气,维持术中循环稳定,改善心功能状态,适合临床应用。
Abstract
Objective To investigate the value of transesophageal echocardiography(TEE)in the detection of ventricular venting after cardiac surgery with cardiopulmonary bypass (CPB).Methods Seventy patients who underwent cardiac surgery with CPB in our hospital from January 2020 to December 2021were randomly divided into the observation group (n=35) monitored by TEE and the control group (n=35) monitored by traditional method. The monitoring Results of the two groups were compared and analyzed.Results The rebeat time of the observation group [(25.12±2.13 ) min]was shorter than that of the control group [(29.45±2.84)min] , and there was statistical difference (t=7.2159.P<0.05). There were different degrees of left cardiac gas in the observation group after CPB, and there were no complications after TEE instruction. Comparison of MAP indexes in T1-T3 time and the lactic acid values between the two groups at T0-T4 time both showed statistical difference (P<0.05). After surgery, LVESD and LVEDD values in observation group were significantly lower than those in the control group, while LVEF values were completely opposite, with statistical significance (P<0.05).Conclusion The clinical value of TEE monitoring in CPB surgery is obvious, which can guide cardiac exhaust, maintain intraoperative circulation stability, and improve cardiac function.
关键词
体外循环 /
心脏手术 /
经食管超声心动图 /
左心内排气
Key words
cardiopulmonary bypass /
heart surgery /
transesophageal echocardiography /
left ventricular venting
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基金
解放军总医院第六医学中心创新培育基金(CXPY201523)
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