许洋洋

[摘要] 目的 探討术中经食管超声心动图（TEE）在心脏外科手术中的应用价值。 方法 回顾性分析2017年1月至2020年6月在我院心外科手术并行术中TEE监测的143例患者，比较术前经胸超声心动图（TTE）检查与TTE联合TEE的诊断符合率，总结术前TEE的补充诊断及对术式的影响，总结术后即刻TEE检查的异常结果及外科处理。 结果 与手术结果对比，术前TTE检查，完全符合率为86.71%，TTE联合TEE诊断后，完全符合率提高到99.12%，差异有统计学意义（P<0.05）;术前TEE检查补充诊断16例，包括瓣膜赘生物4例，卵圆孔未闭4例，房间隔缺损2例，房间隔膨胀瘤+卵圆孔未闭1例，右冠窦瘤破入右室1例，左心耳血栓+二尖瓣机械瓣瓣架血栓1例，二尖瓣生物瓣瓣周漏1例，左心耳血栓1例，左房多发肿瘤1例，其中8例改变手术方案;术后即刻TEE评估手术效果，11例再次进行外科干预处理。 结论 术中TEE既能在术前补充诊断，提高诊断符合率，影响手术方案的决策，又能在术后即刻评估手术效果，及时发现异常并指导外科补救，值得临床推广应用。

[关键词] 超声心动图;经食管;心脏手术;术中监测

[中图分类号] R445.1          [文献标识码] B          [文章编号] 1673-9701（2021）07-0119-04

Application value of intraoperative transesophageal echocardiography in cardiac surgery

XU Yangyang

Echocardiography Room， Quanzhou First Hospital Affiliated to Fujian Medical University， Quanzhou   362000， China

[Abstract] Objective To explore the application value of intraoperative transesophageal echocardiography（TEE） in cardiac surgery. Methods A total of 143 patients who underwent TEE during cardiac surgery in our hospital from January 2017 to June 2020 were analyzed retrospectively. The diagnostic coincidence rate between preoperative transthoracic echocardiography（TTE） and TTE combined with TEE were compared. The supplementary diagnosis of TEE before operation and its influence on the operation method were summarized. The abnormal results and surgical treatment of TEE immediately after operation were recorded. Results Compared with the surgical results， the complete coincidence rate of TTE examination before operation was 86.71%， and after TTE combined with TEE diagnosis， the complete coincidence rate increased to 99.12%， with statistically significant difference（P<0.05）. 16 patients underwent preoperative TEE to supplement the diagnosis， including 4 cases of valvular neoplasm， 4 cases of patent foramen ovale， 2 cases of atrial septal defect， 1 case of atrial septal aneurysm+patent foramen ovale， 1 case of right coronary sinus tumor breaking into the right ventricle， 1 case of left atrial appendage thrombus+mitral valve stent thrombus， 1 case of mitral bioprosthetic valve leakage， 1 case of left atrial appendage thrombus and 1 case of left atrial multiple tumors， among which 8 cases changed the operation plan. TEE was used to evaluate the effect immediately after operation， and 11 cases underwent surgical intervention again. Conclusion Intraoperative TEE can not only supplement the diagnosis before operation， improve the diagnostic coincidence rate and influence the decision-making of the surgical plan， but also evaluate the surgical effect immediately after operation， discover the abnormality in time and guide the surgical remedy， which is worthy of clinical application.

[Key words] Echocardiography; Transesophageal; Cardiac surgery; Intraoperative monitoring

心脏外科手术方式种类多、难度大，是治疗先天性及后天性心脏病的重要方法，随着医疗技术的进步，心脏外科手术的成功率已经大幅度提高，患者的死亡率显著下降。但是仍有少部分患者可能由于术前漏诊或术后并发症等原因面临再次手术的风险。经胸超声心动图（Transthoracic echocardiography，TTE）对患者术前诊断及术后评估起着不可替代的作用，但在心脏外科手术中的监测应用明显受限。而经食管超声心动图（Transesophageal echocardiography，TEE）能避免胸廓、肺气干扰，图像分辨率高，可作为TTE检查的补充，在心脏外科手术中操作更不会影响手术进行，可为心脏外科手术的成功保驾护航。本文回顾在我院心外科手术并行术中TEE监测的病例，探讨术中TEE在心脏外科手术中的应用价值。现报道如下。

1 资料与方法

1.1 一般资料

选取2017年1月至2020年6月在我院心外科手术并行术中TEE监测的143例患者作为研究对象。纳入标准：①在我院心外科手术的心脏病患者;②具有围手术期TEE适应证[1]并行术中TEE监测。……