Reichert C L, Visser C A, Koolen J J, vd Brink R B, van Wezel H B, Meyne N G, Dunning A J
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
J Thorac Cardiovasc Surg. 1992 Aug;104(2):321-6.
Because it is sometimes difficult to determine the cause of hypotension in patients after cardiac operations, we assessed the value of transesophageal echocardiography in this respect, and we studied 60 consecutive patients who had hypotension despite positive inotropic medication and, in some patients, mechanical support. Echocardiographic diagnoses were compared with diagnoses based on hemodynamic parameters. Follow-up examinations were completed in all patients to confirm the final diagnoses. Echocardiographic signs of hypovolemia were present in 14 patients, tamponade in six, left ventricular failure in 16, right ventricular failure in 11, and biventricular failure in eight. Echocardiographic examination proved to be inconclusive in five patients. Comparison with hemodynamic parameters showed agreement on diagnoses (hypovolemia versus tamponade versus cardiac failure) in 30 patients (50%). Echocardiography correctly identified two patients with tamponade and six with hypovolemia; these conditions were not suspected by standard hemodynamic data; in five patients unnecessary reoperation was prevented, although hemodynamic values were suggestive of tamponade. Echocardiography also identified subcategories of patients at high risk of death (those with signs of right ventricular and biventricular failure). These findings suggest that transesophageal echocardiography performed on patients after cardiac operations, at the bedside in the intensive care unit, can readily elucidate the cause of hypotension in the large majority of patients and is a valuable adjunct to hemodynamic evaluation in patient management. Furthermore, it appears to be possible to identify subcategories of high-risk patients, based on these echocardiographic findings.
由于有时难以确定心脏手术后患者低血压的原因，我们评估了经食管超声心动图在这方面的价值。我们连续研究了60例患者，这些患者尽管使用了正性肌力药物，部分患者还使用了机械支持，但仍存在低血压。将超声心动图诊断结果与基于血流动力学参数的诊断结果进行比较。所有患者均完成随访检查以确认最终诊断。14例患者存在血容量不足的超声心动图表现，6例存在心包填塞，16例存在左心室衰竭，11例存在右心室衰竭，8例存在双心室衰竭。5例患者的超声心动图检查结果不明确。与血流动力学参数比较显示，30例患者（50%）在诊断（血容量不足与心包填塞与心力衰竭）上达成一致。超声心动图正确识别出2例心包填塞患者和6例血容量不足患者；这些情况通过标准血流动力学数据未被怀疑；在5例患者中，尽管血流动力学值提示心包填塞，但避免了不必要的再次手术。超声心动图还识别出了死亡高风险患者亚组（那些有右心室和双心室衰竭体征的患者）。这些发现表明，在重症监护病房床边对心脏手术后患者进行经食管超声心动图检查，能够在大多数患者中轻松阐明低血压的原因，并且是患者管理中血流动力学评估的有价值辅助手段。此外，基于这些超声心动图检查结果，似乎有可能识别出高风险患者亚组。
