成人经食管超声心动图的安全性：多学科医院研究。
Safety of transesophageal echocardiography in adults: study in a multidisciplinary hospital.
机构信息
Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.
出版信息
Arq Bras Cardiol. 2009 Nov;93(5):478-83. doi: 10.1590/s0066-782x2009001100007.
BACKGROUND
TEE is a semi-invasive tool broadly used and its utilization associated to sedatives drugs might to affect the procedure safety.
OBJECTIVE
to analyze aspects of TEE safety associated to the use of Midazolan (MZ) and Flumazenil (FL) and the influence of the clinical variables on the event rate.
METHOD
prospective study with 137 patients that underwent TEE with MZ associated to moderate sedation. We analyzed the following events: complications related with the topical anesthesia, with MZ use and with the procedure. Uni- and multivariate analyses were used to test the influence of the clinical variables: age, sex, stroke, myocardiopathy (MP), duration of the test, mitral regurgitation (MR) and the MZ dose.
RESULTS
All patients (65+/-16 yrs; 58% males) finished the examination. The mean doses of MZ and FL were 4.3+/-1.9 mg and 0.28+/-0.2 mg, respectively. The duration of the examination and the mean ejection fraction (EF) were 16.4+/-6.1 minutes and 60+/-9%, respectively. Mild hypoxia (SO2<90%) was the most common event (11 patients); 3 patients (2%) presented transient hypoxia due to upper airway obstruction by probe introduction and 8 (5.8%) due to hypoxia caused by MZ use. Transient hypotension (SAP<90mmHg) occurred in 1 patient (0.7%). The multivariate analysis showed that severe MR, MP (EF<45%) and high doses of MZ (>5mg) were associated with events (p<0.001). The EF was 40%, in the group with MP and 44% in the group with severe MR and it can be a factor associated with clinical events in the last group.
CONCLUSION
TEE with sedation presents a low rate of events. There were no severe events and there was no need to interrupt the examinations.
背景
TEE 是一种半侵入性工具，广泛应用，其与镇静药物的使用可能会影响程序的安全性。
目的
分析与使用咪达唑仑（MZ）和氟马西尼（FL）相关的 TEE 安全性方面，以及临床变量对事件发生率的影响。
方法
对 137 例接受 MZ 联合中度镇静的 TEE 的患者进行前瞻性研究。我们分析了以下事件：局部麻醉、MZ 使用和程序相关的并发症。使用单因素和多因素分析来测试临床变量的影响：年龄、性别、中风、心肌病变（MP）、测试持续时间、二尖瓣反流（MR）和 MZ 剂量。
结果
所有患者（65+/-16 岁；58%为男性）均完成了检查。MZ 和 FL 的平均剂量分别为 4.3+/-1.9mg 和 0.28+/-0.2mg。检查持续时间和平均射血分数（EF）分别为 16.4+/-6.1 分钟和 60+/-9%。轻度缺氧（SO2<90%）是最常见的事件（11 例）；3 例（2%）因探头插入引起上呼吸道阻塞而出现短暂缺氧，8 例（5.8%）因 MZ 使用引起缺氧。1 例（0.7%）患者出现短暂低血压（SAP<90mmHg）。多因素分析显示，严重的 MR、MP（EF<45%）和高剂量的 MZ（>5mg）与事件相关（p<0.001）。在 MP 组中 EF 为 40%，在严重 MR 组中 EF 为 44%，这可能是后一组临床事件的相关因素。
结论
镇静 TEE 事件发生率低。没有严重事件，也不需要中断检查。
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