Rafferty T D
Dept. of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510.
Yale J Biol Med. 1991 Jul-Aug;64(4):375-85.
Swan-Ganz catheterization can facilitate intra-operative management of critically ill patients. The derived data lacks specificity, however, and, as such, is frequently misleading. This disadvantage, combined with recent advances in echocardiography imaging techniques, has resulted in increasing application of transesophageal (TE) two-dimensional echocardiography (2D-echo) to supplement and, in instances, to supplant conventional cardiac monitoring. This paper reviews the current status of single-plane TE 2D-echo as it pertains to evaluation of left ventricular (LV) volume status, performance, and ischemia. It is concluded that, while 2D-echo multiple-plane analyses provide an accurate representation of LV dimensions, interpretation of TE single-plane end-diastolic measurements should be limited to differentiation between extremes of LV volume. In contrast, corresponding estimates of LV ejection fraction correlate closely with overall performance, at least in cases without asynergy. Finally, the capacity of TE 2D-echo to detect LV regional wall-motion abnormalities can be particularly useful. Such abnormalities commonly represent early manifestations of ischemia and can, in addition, be predictive of subsequent outcome.
Swan-Ganz导管插入术有助于危重症患者的术中管理。然而，所获得的数据缺乏特异性，因此常常具有误导性。这一缺点，再加上超声心动图成像技术的最新进展，导致经食管（TE）二维超声心动图（2D-回波）的应用日益增多，以补充并在某些情况下取代传统的心脏监测。本文综述了单平面TE 2D-回波在评估左心室（LV）容量状态、功能和缺血方面的现状。得出的结论是，虽然2D-回波多平面分析能准确反映LV尺寸，但TE单平面舒张末期测量结果的解释应仅限于区分LV容量的极端情况。相比之下，LV射血分数的相应估计值与整体功能密切相关，至少在无协同失调的情况下如此。最后，TE 2D-回波检测LV节段性室壁运动异常的能力可能特别有用。此类异常通常是缺血的早期表现，此外，还可预测后续结果。
