李强 1卢彬 1缪冬梅 1余璇 1郭飞 1王君 1范彬 1郑业英1
作者信息
- 1. 自贡市第四人民医院麻醉科，四川643000
- 折叠
摘要
Abstract
Objective To investigate the application value of transesophageal echocardiography (TEE) monitoring in the selection of cardiac valve surgery mode,evaluation of operative effect,left heart exhaust and anesthesia circulation management of heart valve operation. Methods Forty ASA gradeⅡ~Ⅲpatients with heart valve disease undergoing surgical treatment in our hospital from May 2014 to June 2015 were randomly divided into the TEE monitoring group (T) and conventional monitoring group (C) according to the random number table method,20 cases in each group. The group T replenished or perfected preopera-tive diagnosis,changed or adjusted the case number of operation scheme,evaluated the operative effect,monitored the left heart gas degree and excluding situation. FAC,AVTI,SV and CI in the group T were compared between before and after operation. The time from heart rebeating to CPB machine stopping ,MAP and lactic acid values at time points of instantly after CBP machine stopping (T0),at 10 min (T1),30 min (T2),60 min (T3) after CBP machine stopping were compared between the two groups . Results In the group T,2 cases replenished the preoperative diagnosis,4 cases adjusted the planning operation mode,and no case developed the serious postoperative complications such as postoperative valve movement abnormality ,perivalvular leakage or obvious acceleration of transvalve blood flow. One case in the groups T appeared severe reflux after tricuspid severe reflux forming operation without special treatment due to no suitable artificial valve; in all cases of the group T,different degrees of gas were found in the left heart after heart rebeating,sufficient exhaust was performed,no related complications caused by gas embolism were found during postoperative follow up. No case of TEE operating complication occurred in the group T. All cases were cured and discharged with rehabilitation. Postoperative FAC,AVTI,SV and CI in the group T were(0.50±0.05),(25.1±6.5)cm,(71.0± 6.0)mL and(2.90±0.74)L/(min·m2) respectively,which before operation were(0.43±0.08),(24.5±7.8)cm,(65.0±8.0)mL and (2.70±0.87)L/(min·m2) respectively,the differences were statistically significant(P<0.05). The mean time of the heart rebeating to CPB machine stopping in the group T was(26.75±5.66) min,which in the group C was(28.99±5.96) min,the difference between the two groups was statistically significant(P<0.05) . The MAP values after machine stopping in the group T had no statistical dif-ference among different time points (P>0.05),while which in the group C had statistical difference (P<0.05). The lactic acid val-ues after machine stopping in the two groups had statistical differences among different time points (P<0.05). Conclusion The TEE monitoring has an important role in the aspects of preoperative reevaluation of valve situation ,postoperative instant evalua-tion of operative effect,guiding intraheart exhausting gas,CPB machine stopping and anesthesia circulation,which provides the guarantee for operation success.关键词
超声心动描记术,经食管/监测,手术中/心脏瓣膜/外科学/麻醉Key words
Echocardiography,transesophageal/Monitoring,intraoperative/Heart valves/surgery/Anesthesia
