CAJ | 학술논문

目的探讨术中经食管超声心动图(TEE)在肺移植术中的应用价值.方法 2005年8月至2009年8月,19例平均年龄(48.35±13.04)岁的肺疾病晚期病人行肺移植手术.于肺移植术前麻醉后送入TEE探头,检测左、右肺静脉开口和肺动脉血流速度,右室壁运动,左、右心室容积,右室射血分数.观察房间隔有无交通.肺移植术中分别于断肺后和供肺支气管、肺静脉、肺动脉全部吻合开放后连续观察上述指标.结果 19例中6例为序贯式双肺移植,13例单肺移植,其中左叶肺移植2例、右叶肺移植11例.术中阻断一侧被移植肺的动、静脉后,该侧肺动、静脉血流消失,右室容积轻度增大.供体肺与受体肺全部气管、肺静脉、肺动脉吻合完毕开放后,右室容积恢复.TEE依次检测肺静脉、肺动脉吻合口,吻合口流速均轻度增快.开放后发现1例右肺动脉血流速度显著增快,经重新吻合后血流速度降低,血氧分压恢复.术中发现3例卵圆孔未闭.结论 TEE在肺移植术中监测肺动脉和肺静脉血管吻合口直径和血流速度,检测右心功能,对并发症的预测等起重要作用.
목적 탐토술중경식관초성심동도(TEE)재폐이식술중적응용개치.방법 2005년8월지2009년8월,19례평균년령(48.35±13.04)세적폐질병만기병인행폐이식수술.우폐이식술전마취후송입TEE탐두,검측좌、우폐정맥개구화폐동맥혈류속도,우실벽운동,좌、우심실용적,우실사혈분수.관찰방간격유무교통.폐이식술중분별우단폐후화공폐지기관、폐정맥、폐동맥전부문합개방후련속관찰상술지표.결과 19례중6례위서관식쌍폐이식,13례단폐이식,기중좌협폐이식2례、우협폐이식11례.술중조단일측피이식폐적동、정맥후,해측폐동、정맥혈류소실,우실용적경도증대.공체폐여수체폐전부기관、폐정맥、폐동맥문합완필개방후,우실용적회복.TEE의차검측폐정맥、폐동맥문합구,문합구류속균경도증쾌.개방후발현1례우폐동맥혈류속도현저증쾌,경중신문합후혈류속도강저,혈양분압회복.술중발현3례란원공미폐.결론 TEE재폐이식술중감측폐동맥화폐정맥혈관문합구직경화혈류속도,검측우심공능,대병발증적예측등기중요작용.
Objective To investigate the clinical value of transesophageal echocardiography during the lung transplanta tion. Methods From August 2005 to August 2009, 19 patients with advanced lung diseases received lung transplantation.The average age was(48.35±13.04) years. The echocardiographic probe was placed in patient's esophagus before surgery.The left and right pulmonary venous openings, artery blood flow velocity, right ventricular wall motion, left and right ventricular volume, right ventricular ejection fraction were recorded at different time intervals during lung transplantation, especially at the break and after completion of bronchus, pulmonary veins, and pulmonary artery anastomosis. Results The procedure included sequential-type lung transplantation in 6 cases and single lung transplantation in 13. The blood flow disappeared when blocking pulmonary artery and vein and right ventricular volume increased slightly. The right ventricular volume restored after completion of trachea, pulmonary veins, pulmonary artery anastomosis. TEE detected that the blood flow velocity of pulmonary veins, pulmonay artery anastomosis increased slightly. In 1 case the opening of the right pulmonsry artery blood flow velocity increased significantly and blood flow velocity decresed and blood oxygen partial pressure resumed after re-anastomosis of pulmonary artery. Conclusion TEE play an important role in monitoring pulmonary artery and vein anastomosis diameter and blood flow velocity and right ventricular function and predicting complications during lung transplantation.