Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Ann Thorac Surg. 2010 Oct;90(4):1080-6. doi: 10.1016/j.athoracsur.2010.05.019.
We used echocardiographically derived myocardial performance index (MPI) to assess changes in global right ventricular function with lung isolation. We hypothesized that changes in MPI with lung isolation may be related to the incidence of postoperative supraventricular tachycardia (SVT).
Transesophageal echocardiographic examinations were performed after induction of general anesthesia in patients undergoing elective lung resections. Doppler tissue imaging was used to calculate MPI at baseline and 10 minutes after institution of one-lung ventilation (OLV). Arrhythmias occurring within the first 5 postoperative days were recorded.
Fifty-nine patients completed the study. Nineteen of 59 patients with a normal baseline MPI (<0.40) had a higher incidence of SVT as compared with patients with an abnormal baseline MPI (42% versus 10%; p = 0.012). The MPI worsened during OLV in 46 patients; a worsening of MPI with lung isolation that was normal at baseline was associated with higher incidence of SVT (57% versus 0%; p = 0.045) compared with a worsening of MPI in patients with an abnormal baseline MPI (13% versus 6%; p = 0.62). A normal baseline MPI value that worsened after OLV, left atrial dilation, and advanced age were identified as predictors of postoperative SVT.
Lung isolation is associated with acute changes in global right ventricular function. A normal baseline MPI that worsens after lung isolation is a better predictor of postoperative SVT as compared with baseline abnormal MPI that does not worsen after lung isolation. Myocardial performance index has a potential to be used as a right ventricular stress test to tolerate OLV before thoracic surgery.
我们使用超声心动图衍生的心肌做功指数（MPI）来评估肺隔离对整体右心室功能的变化。我们假设肺隔离后 MPI 的变化可能与术后室上性心动过速（SVT）的发生率有关。
在择期行肺切除术的患者全麻诱导后进行经食管超声心动图检查。使用多普勒组织成像技术在基线和单肺通气（OLV）开始后 10 分钟计算 MPI。记录术后 5 天内发生的心律失常。
59 例患者完成了研究。与基线 MPI 异常（>0.40）的 59 例患者相比，19 例基线 MPI 正常（<0.40）的患者 SVT 发生率更高（42%比 10%；p=0.012）。46 例患者在 OLV 期间 MPI 恶化；与基线 MPI 异常患者（13%比 6%；p=0.62）相比，基线 MPI 正常但 OLV 后恶化的患者发生 SVT 的发生率更高（57%比 0%；p=0.045）。OLV 后基线 MPI 值恶化、左心房扩张和年龄较大被确定为术后 SVT 的预测因素。
肺隔离与整体右心室功能的急性变化有关。与基线异常 MPI 不恶化相比，OLV 后基线正常 MPI 恶化是术后 SVT 的更好预测因素。MPI 有可能作为一种右心室应激试验，用于预测胸部手术前的 OLV 耐受能力。
