Heidenreich P A, Stainback R F, Redberg R F, Schiller N B, Cohen N H, Foster E
Department of Medicine, University of California, San Francisco 94143-0214, USA.
J Am Coll Cardiol. 1995 Jul;26(1):152-8. doi: 10.1016/0735-1097(95)00129-n.
This study sought to determine the prognostic yield and utility of transesophageal echocardiography in critically ill patients with unexplained hypotension.
Transesophageal echocardiography is increasingly utilized in the intensive care setting and is particularly suited for the evaluation of hypotension; however, the prognostic yield of transesophageal echocardiography in these patients is unknown.
We prospectively studied 61 adult patients in the intensive care unit with sustained (> 60 min) unexplained hypotension. Both transthoracic and transesophageal echocardiography were performed, and results were immediately disclosed to the primary physician, who reported any resulting changes in management. Patients were classified on the basis of transesophageal echocardiographic findings into one of three prognostic groups: 1) nonventricular (valvular, pericardial) cardiac limitation to cardiac output; 2) ventricular failure; and 3) noncardiac systemic disease (hypovolemia or low systemic vascular resistance, or both). Primary end points were death or discharge from the intensive care unit.
A transesophageal echocardiographic diagnosis of nonventricular limitation to cardiac output was associated with improved survival to discharge from the intensive care unit (81%) versus a diagnosis of ventricular disease (41%) or hypovolemia/low systemic vascular resistance (44%, p = 0.03). Twenty-nine (64%) of 45 transthoracic echocardiographic studies were inadequate compared with 2 (3%) of 61 transesophageal echocardiographic studies (p < 0.001). Transesophageal echocardiography contributed new clinically significant diagnoses (not seen with transthoracic echocardiography) in 17 patients (28%), leading to operation in 12 (20%).
Transesophageal echocardiography makes a clinically important contribution to the diagnosis and management of unexplained hypotension and predicts prognosis in the critical care setting.
本研究旨在确定经食管超声心动图对不明原因低血压的危重病患者的预后价值及实用性。
经食管超声心动图在重症监护环境中的应用日益广泛，尤其适用于低血压的评估；然而，经食管超声心动图在这些患者中的预后价值尚不清楚。
我们前瞻性地研究了61例重症监护病房中患有持续（>60分钟）不明原因低血压的成年患者。同时进行了经胸和经食管超声心动图检查，并将结果立即告知主治医生，由其报告管理方面的任何变化。根据经食管超声心动图检查结果，将患者分为三个预后组之一：1）非心室性（瓣膜性、心包性）心输出量受限；2）心室衰竭；3）非心脏性全身性疾病（血容量不足或低体循环血管阻力，或两者兼有）。主要终点是死亡或从重症监护病房出院。
经食管超声心动图诊断为非心室性心输出量受限的患者，其从重症监护病房出院的生存率较高（81%），而诊断为心室疾病（41%）或血容量不足/低体循环血管阻力（44%，p=0.03）的患者生存率较低。45例经胸超声心动图检查中有29例（64%）结果不充分，而61例经食管超声心动图检查中只有2例（3%）结果不充分（p<0.001）。经食管超声心动图在17例患者（28%）中得出了新的具有临床意义的诊断（经胸超声心动图未发现），其中12例（20%）因此接受了手术。
经食管超声心动图对不明原因低血压的诊断和管理具有重要的临床贡献，并能预测重症监护环境中的预后。
