经食管超声心动图监测在心血管手术患者中的应用

对本院1997年6月至2001年6月493例心血管手术患者术中TEE的应用情况进行回顾性研究。经TEE更正诊断20例（占4．1％），补充诊断51例（占10．3％），因此而改变手术模式52例（占10．5％）；发现手术失败24例（占4．9％），发现血流或心功能异常17例（占3．4％）；漏诊21例和误诊6例；操作过程中发生口、咽粘膜出血7例，老年患者牙齿松动1例，所有患者术后随访无上消化道穿孔或出血等与TEE检查有关的并发症。TEE技术是一种直观、功能全面的监测手段，对手术操作和麻醉管理具有指导作用，可列为心血管术中常规监测手段。     

心脏手术中经食管超声心动图监测的应用

１９９４年１月～１９９７年５月,对１４６例心脏手术患者行经食管超声心动图（ＴＥＥ）术中监测,现分析如下。１临床资料与方法１．１一般资料本组共１４６例,男７０例,女７６例。年龄１３～７３岁,平均３４．６岁。手术病种包括先天性心脏病（房、室间隔缺损、法洛...     

经食管超声心动图在心脏手术麻醉中的应用

评估经食管超声心动图在心脏手术麻醉中的应用价值。方法；通过对４年来１３１例心脏手术病人麻醉中ＴＥＥ监测，对术中常规排气病人，体外停机前后气体出现情况和其中３８例风心病二尖瓣置换病人换瓣前后瓣膜返流等进行对比观察，气体量和返流量根据ＴＥＥ所见分别分为４级和５级。     

经食管超声心动图在肝移植手术中的应用

肝移植手术由于患者合并症多、手术操作复杂,常发生剧烈的血流动力学波动。经食管超声心动图（transesophageal echocardiography,TEE）作为一种可视化工具,能实时连续监测心血管结构与功能,鉴别相应的病因,优化麻醉管理,评估移植肝的功能,改善患者预后,被推荐用于高危的肝移植手术。由于肝病患者的特...     

大血管手术和经食管超声心动图

术中应用经食管超声心动图（TEE）推动了大血管手术的诊断和治疗。现总结近5年来TEE在动脉夹层、动脉瘤、动脉外伤、粥样硬化、腔静脉血栓和血管支架腔内植入等手术中的应用,并对TEE的优点和不足进行评价。     

经食管超声心动图在机器人心脏手术中的应用

目的探讨经食管超声心动图(transesophageal echocardiography,TEE)在机器人体外循环心脏手术中的应用价值。 方法对110例心脏病患者在机器人体外循环术中行TEE检查,体外循环转机前评估心脏病变,验证经胸超声心动图(transthoracic echocardiography,TTE)结果,根据结果协助手术医师进一步确定手术方案。建议外周体外循环过程中,TEE引导下腔静脉插管(经股静脉)、上腔静脉插管(经右侧颈内静脉)。心脏复搏后,TEE评估手术疗效、手术并发症、排气情况。将其结果进行回顾性分析。 结果本组患者全在机器人下完成手术,其中2例中转右前外侧切口。体外循环转机前TEE诊断与TTE结果有7例不相符,经术中证实TEE准确性100%。TEE引导所有下、上腔静脉插管成功,成功率100%,体外循环过程中无静脉引流不畅。心脏复搏后2例室间隔缺损有残余分流、1例二尖瓣成形后仍有中度反流、1例主动脉瓣置换术后瓣周漏,经再次阻断处理后均取得满意效果。其余患者手术疗效确切,术后再次TTE证实无手术相关并发症。 结论TEE在机器人体外循环术中能提高手术成功率及安全性,是有效的术中诊断手段。     

经食管超声心动图在心外手术心脏辅助中的应用

心脏辅助技术在终末期心脏病或濒死心脏病的应用，是近年来心脏外科治疗方面最重要的进展之一。目前，心脏辅助在临床上最常见的适应症包括：1．心脏直视术后严重低心排；2．大面积心肌梗死；3．心脏移植术前后。     

经食管超声心动图在小儿先天性心脏病围手术期的应用

先天性心脏病围手术期经食管超声心动图在提高诊断的准确性、即刻评估手术效果和提高治愈率、监测心功能、指导麻醉管理及药物治疗、降低术后并发症发生率和死亡率等方面极具应用价值。     

Therapeutic impact of intra-operative transoesophageal echocardiography during noncardiac surgery

The impact of transoesophageal echocardiography on haemodynamic management during elective noncardiac surgery was assessed during this observational prospective database analysis. Ninety-nine consecutive patients were studied, who were at risk of intra-operative myocardial ischaemia or haemodynamic instability (Class II indications) and were undergoing vascular, visceral or chest surgery. A total of 165 new echocardiographic findings were recorded. Based on these findings changes in drug therapy were made in 47% and changes in fluid therapy in 24% of patients. Left ventricular wall motion abnormalities were seen in 32% and other relevant diagnoses made in 10%. Echocardiography showed a significant impact on drug therapy in patients with pre-operative systolic wall motion abnormalities (vasodilators: OR = 7.1, CI 95% = 2.1/24.0; vasopressors: OR = 3.3, CI 95% = 1.2/9.1) and patients with a history of left heart failure (vasodilators: OR = 5.2, CI 95% = 1.0/31.4). Fluid therapy was significantly influenced by echocardiographic findings during liver and lung transplantation (50% compared with 24% during other surgical interventions, p < 0.05).     

右美托咪定在心血管手术麻醉中的应用价值和进展

背景右美托咪定(dexmedetomidine,Dex)是高选择性α2肾上腺素能受体激动剂,具有镇静、镇痛、抗焦虑及抑制交感和应激反应的作用,已广泛应用于临床麻醉,近期研究表明Dex在心血管手术麻醉中有一定的应用价值.目的 阐述Dex在心血管手术麻醉中应用的适用性、有效性和安全性,为临床应用提供参考.内容概述Dex在心血管手术麻醉围手术期具有的稳定血流动力学、抗心律失常、器官保护、防治术后谵妄和抗炎作用以及副作用的防范.趋向Dex在心血管手术麻醉中有一定的应用价值,但需要进一步研究明确Dex的临床应用范围、副作用及处理措施,以便更好地应用于临床.     

Transoesophageal echocardiography is unreliable for cardiac output assessment after cardiac surgery compared with thermodilution

This randomised, single-blind, double-control study compared and established prospectively the best transoesophageal echocardiography methods for determining cardiac output in patients after cardiac surgery. Thirty patients undergoing coronary artery bypass grafting were included. Measurements were taken postoperatively, after stabilisation in the intensive care unit. Cardiac output was determined by transoesophageal echocardiography in randomised order through the aortic, mitral, and pulmonary valves, right and left ventricular outflow tracts, transgastric surface areas of the left ventricle and left ventricle two-dimensional volumes (Simpson's rules). 'Eyeball guessing' was done off-line. The best results were transaortic measurements using the triangular shape assumption of valve opening, but some values deviated considerably, and none of these approaches reached the limit of agreement set at 30% when compared to thermodilution. Eyeball guessing was comparable to the best transoesophageal echocardiography measurements. We conclude that transoesophageal echocardiography is an unreliable tool for determination of cardiac output in intensive care after cardiac surgery.     

The importance of intraoperative transoesophageal monitoring when operating on renal cancers that involve the right atrium

The surgical treatment of advanced renal cancers is challenging. Renal cell carcinoma is interesting in that it invades the vasculature and can extend up as far as the right atrium. Extension of tumour thrombus into the right atrium represents level IV disease, according to Robson staging. Transoesophageal echocardiography is useful for diagnostic purposes. It is also of great value for intraoperative cardiac monitoring and to confirm the extent of vascular involvement.     

Myocardial ischaemia as judged from transoesophageal echocardiography and ECG in the early phase after coronary artery bypass surgery

The incidence of myocardial ischaemia, as diagnosed by transoesophageal echocardiography (TEE) versus ECG, and the relationship between ischaemic events and haemodynamic parameters were studied in 30 patients in the early phase after coronary artery bypass grafting. Information comprising invasive haemodynamics, TEE measurements, and 12-lead ECG was obtained on arrival of the patient in the intensive care unit (ICU), and then hourly in the ICU for 5 h. In the ICU, TEE signs of ischaemia were found in 14 patients and ECG signs of ischaemia in six patients. The ischaemic events were not related to levels of blood pressure or heart rate. Three patients showed signs of myocardial infarction postoperatively. All three of these patients showed both TEE and ECG signs of ischaemia in the ICU. It was concluded that TEE reveals more ischaemic events than ECG in the early postoperative period and that these ischaemic events do not correlate with the haemodynamic indices.     

Impact of intraoperative transesophageal echocardiography during noncardiac surgery

OBJECTIVE: The purpose of this study was to test if parameters measured by intraoperative transesophageal echocardiography (TEE) could be useful to evaluate the hemodynamic status of high-risk cardiovascular patients and if this information was sufficient to make changes in intraoperative management. DESIGN: Prospective clinical study. SETTING: Single-university hospital. PARTICIPANTS: Ninety-eight patients undergoing noncardiac surgery. INTERVENTIONS: Every patient was assessed with a baseline examination of 2-dimensional, color, pulsed, and continuous Doppler images. Intraoperative changes in any of the evaluated and measured parameters led to a specific change according to the protocol. MEASUREMENTS AND MAIN RESULTS: After continuous monitoring with TEE during surgery, all patients were assigned to 1 of the following groups: (1) TEE was of no use, (2) TEE-directed intraoperative management changes, (3) intraoperative TEE-directed changes in postoperative management, and (4) TEE successfully used as a substitute for pulmonary artery catheter monitoring. Two patients (2%) were assigned to group 1, 47 (48%) patients to group 2, 25 (25%) patients to group 3, and 24 (24%) patients to group 4. The most frequent modifications in intraoperative management were changes in drug therapy and fluid administration. Postoperative management changes were mostly made because of new diagnosis (14%) and new left ventricular wall motion abnormalities (9%). CONCLUSION: These results strongly suggest that objective measurements made by intraoperative TEE are effective in unveiling relevant clinical findings and useful information in high-risk patients undergoing noncardiac surgery.     

Transthoracic and transoesophageal echocardiography: a systematic review of feasibility and impact on diagnosis,management and outcome after cardiac surgery

Transthoracic and transoesophageal echocardiography are increasingly used as tools to improve clinical assessment following cardiac surgery. However, most physicians are not trained in echocardiography, and there is no widespread agreement on the feasibility, indications or effect on outcome of transthoracic or transoesophageal echocardiography for patients after cardiac surgery. We performed a systematic review of electronic databases for focused transthoracic and transoesophageal echocardiography after cardiac surgery which revealed 15 full‐text articles. They consistently reported that echocardiography is feasible, whether performed by a novice or expert, and frequently resulted in important changes in diagnosis of cardiac abnormalities and their management. However, most were observational studies and there were no well‐designed trials investigating the impact of echocardiography on outcome. We conclude that both transthoracic and transoesophageal echocardiography are useful following cardiac surgery.