不同经食管超声心动图技术对心脏手术患者进行预负荷评估的准确性。

The accuracy of preload assessment by different transesophageal echocardiographic techniques in patients undergoing cardiac surgery.

作者信息

Hofer Christoph K, Ganter Michael T, Rist Andreas, Klaghofer Richard, Matter-Ensner Sonja, Zollinger Andreas

机构信息

Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Zurich, Switzerland.

出版信息

J Cardiothorac Vasc Anesth. 2008 Apr;22(2):236-42. doi: 10.1053/j.jvca.2007.06.007. Epub 2007 Aug 22.

DOI:10.1053/j.jvca.2007.06.007

PMID:18375326

Abstract

OBJECTIVES

The aim of this study was to compare the following approaches to assess left ventricular preload by transesophageal echocardiography (TEE): left ventricular end-diastolic volume index (LVEDVI) determined by using the method of disc summation (LVEDVI(Md)) and left ventricular end-diastolic area index (LVEDAI) were compared with LVEDVI assessed by the modified Simpson formula (LVEDVI(Si)). Global end-diastolic volume index (GEDVI) and stroke volume index (SVI) measured by the PiCCO(plus) system (Pulsion Medical Systems, Munich, Germany) were used as TEE-independent reference variables.

DESIGN

Prospective observational study.

SETTING

Community hospital.

PARTICIPANTS

Twenty-two patients undergoing elective cardiac surgery.

INTERVENTIONS

After the induction of anesthesia, hemodynamic assessment by TEE and the PiCCO(plus) system was made 20 (T(1)) and 10 minutes (T(2)) before and 10 (T(3)) and 20 minutes (T(4)) after a fluid trial. At each time point, LVEDVI(Md), LVEDAI, LVEDVI(Si), GEDVI, and SVI were determined.

MEASUREMENTS AND MAIN RESULTS

The fluid trial resulted in a significant increase of all preload variables measured at T(3). At T(4), all preload variables but LVEDVI(Md) showed a significant decrease. The mean bias +/- 2 SD for percent changes (Delta) of LVEDVI(Md) - DeltaLVEDVI(Si) was 1.5% +/- 59.0% and for DeltaLVEDAI - Delta LVEDVI(Si) 0.9% +/- 23.6%. The correlation between LVEDVI(Md) and LVEDVI(Si) was significantly weaker than between LVEDAI and LVEDVI(Si) (p < 0.001). Comparing TEE measurements with GEDVI and SVI, strong correlations were observed for LVEDAI and LVEDVI(Si) only.

CONCLUSION

The method of disc summation cannot be recommended for preload assessment during a fluid challenge in cardiac surgery patients. By contrast, single-plane area measurements provided reliable information when compared with the application of the modified Simpson formula.

摘要

目的

本研究旨在比较经食管超声心动图（TEE）评估左心室前负荷的以下方法：采用圆盘求和法测定的左心室舒张末期容积指数（LVEDVI(Md)）和左心室舒张末期面积指数（LVEDAI），并与采用改良Simpson公式评估的LVEDVI（LVEDVI(Si)）进行比较。使用PiCCO(plus)系统（德国慕尼黑Pulsion Medical Systems公司）测量的全心舒张末期容积指数（GEDVI）和每搏量指数（SVI）作为与TEE无关的参考变量。

设计

前瞻性观察性研究。

地点

社区医院。

参与者

22例接受择期心脏手术的患者。

干预措施

麻醉诱导后，在液体试验前20分钟（T(1)）和10分钟（T(2)）以及液体试验后10分钟（T(3)）和20分钟（T(4)），通过TEE和PiCCO(plus)系统进行血流动力学评估。在每个时间点，测定LVEDVI(Md)、LVEDAI、LVEDVI(Si)、GEDVI和SVI。

测量指标及主要结果

液体试验导致T(3)时测量的所有前负荷变量显著增加。在T(4)时，除LVEDVI(Md)外的所有前负荷变量均显著降低。LVEDVI(Md) - DeltaLVEDVI(Si)的百分比变化（Delta）的平均偏差±2SD为1.5%±59.0%，DeltaLVEDAI - Delta LVEDVI(Si)的平均偏差±2SD为0.9%±23.6%。LVEDVI(Md)与LVEDVI(Si)之间的相关性明显弱于LVEDAI与LVEDVI(Si)之间的相关性（p < 0.001）。将TEE测量结果与GEDVI和SVI进行比较时，仅观察到LVEDAI和LVEDVI(Si)之间存在强相关性。