CAJ | 학술논문

超声心动图监测体外膜肺氧合治疗二尖瓣置换术后的低心输出量综合征
초성심동도감측체외막폐양합치료이첨판치환술후적저심수출량종합정

万方数据

当代医学噹代醫學 당대의학
CHINA CONTEMPORARY MEDICINE
2013年 18期 63-64 ,共2页

刘少中%刘晓真%叶木奇%叶红雨%黄泳航%周广新%鼎华%杨坤%唐渲%徐伟

류소중%류효진%협목기%협홍우%황영항%주엄신%정화%양곤%당선%서위

超声心动描记术%体外膜肺氧合治疗%二尖瓣置换%低心输出量综合征超聲心動描記術%體外膜肺氧閤治療%二尖瓣置換%低心輸齣量綜閤徵
초성심동묘기술%체외막폐양합치료%이첨판치환%저심수출량종합정
Echocardiography%Extracorporeal Membrane Oxygenation%Mitral Valve Replacement%Low Cardiac Output Syndrom

目的探讨在使用体外膜肺氧合治疗(ECMO)二尖瓣置换术后低心输出量综合征时，应用超声心动图对其进行监测的价值。方法选取2008年7月-2013年1月行二尖瓣人工机械瓣置换术后因出现低心输出量综合征接受ECMO治疗的患者21例，年龄35～62岁，平均(50±13)岁，男性6例，女性15例。应用超声心动图分别在4个时点(ECMO建立前、ECMO建立后即刻、ECMO流量减半时、ECMO停机后即刻)测量左室射血分数及Tei指数，同时记录各时点的肱动脉收缩压(sBP)、肱动脉舒张压(dBP)、动脉血氧饱和度(SaO 2)，并对比各参数在各时点的变化。结果于ECMO流量减半时、ECMO撤离后即刻分别与ECMO建立后即刻比较，LVEF均有所增加，差异有统计学意义(P＜0.05)；Tei指数均降低，差异有统计学意义(P＜0.05)。临床资料显示，ECMO流量减半时、ECMO撤离后即刻分别与ECMO建立前比较，sBP、dBP、SaO 2均有所改善，差异有统计学意义(P＜0.05)。结论在应用ECMO治疗二尖瓣置换术后出现低心输出量综合征患者中，应用超声心动图能对患者心脏进行有效监测，为临床判断ECMO疗效、掌握撤机时机提供重要的心脏功能参数。
목적탐토재사용체외막폐양합치료(ECMO)이첨판치환술후저심수출량종합정시，응용초성심동도대기진행감측적개치。방법선취2008년7월-2013년1월행이첨판인공궤계판치환술후인출현저심수출량종합정접수ECMO치료적환자21례，년령35～62세，평균(50±13)세，남성6례，녀성15례。응용초성심동도분별재4개시점(ECMO건립전、ECMO건립후즉각、ECMO류량감반시、ECMO정궤후즉각)측량좌실사혈분수급Tei지수，동시기록각시점적굉동맥수축압(sBP)、굉동맥서장압(dBP)、동맥혈양포화도(SaO 2)，병대비각삼수재각시점적변화。결과우ECMO류량감반시、ECMO철리후즉각분별여ECMO건립후즉각비교，LVEF균유소증가，차이유통계학의의(P＜0.05)；Tei지수균강저，차이유통계학의의(P＜0.05)。림상자료현시，ECMO류량감반시、ECMO철리후즉각분별여ECMO건립전비교，sBP、dBP、SaO 2균유소개선，차이유통계학의의(P＜0.05)。결론재응용ECMO치료이첨판치환술후출현저심수출량종합정환자중，응용초성심동도능대환자심장진행유효감측，위림상판단ECMO료효、장악철궤시궤제공중요적심장공능삼수。
Objective To investigate the value of monitoring by echocardiography(UCG), while patients with low cardiac output syndrome(LCOS) after mitral valve replacement were treated by extracorporeal membrane oxygenation(ECMO). Methods 21 cases, who were treated by ECMO because of LCOS, were selected. The left ventricular ejection fraction(LVEF) and Tei index were measured by UCG before the ECMO set up, when the ECMO set up immediately, the ECMO flow stepping down to one half, and the ECMO stopped immediately. The systolic blood pressure(sBP) and the diastolic blood pressure(dBP) of the brachial artery, as well as the arterial oxygen saturation(SaO 2), were recorded. The parameters were compared. Results The LVEF increased when the ECMO flow stepped down to one half and the ECMO stopped immediately, respectively compared with that when the ECMO set up immediately, there being significant difference (P=0.022, 0.018 respectively), and the Tei index decreasing(P=0.021, 0.015 respectively), while the sBP, dBP and SaO 2 all increasing ( P<0.05 respectively).Conclusion While treating patients with low cardiac output syndrome after mitral valve replacement by extracorporeal membrane oxygenation, the echocardiography can montoring the heart effectively, and provide important parameters of the cardiac function for the clinical doctors to estimate the ECMO efficacy and decide the time of setting it down.