Pérez de Prádo A, García-Fernández M A, Barambio M, Moreno M, Torrecilla E G, San Román D, Delcán J L
Departamento de Cardiología, Hospital General Gregorio Marañón, Madrid.
Rev Esp Cardiol. 1994 Nov;47(11):735-40.
It's well known the utility of transesophageal echocardiography in the evaluation of cardiological patients that are critically ill. However, there is less experience about this usefulness in non-cardiological critically ill patients.
To assess the utility and safety of the method we analyzed 51 correlative studies of patients admitted to our general Intensive Care Unit. Forty-seven patients (92%) were on mechanical ventilation and in 24 patients (47%) continuous assessment of the hemodynamic variables were available.
The most frequent diagnoses on admission were sepsis (23.5%) and shock status (17.6%). The indications were: suspicion of endocarditis (15 patients), hemodynamic instability (11 cases), cardiac source of embolus (10), suspicion of cardiac tamponade (4), suspicion of aortic dissection (4) and other causes in 7. The study confirmed the clinical suspicion in 31 cases (60.8%), excluded it in 15 (29.4%) and established a new, non-suspected, diagnosis in 5 patients (9.8%). There were major diagnostic changes in 16 patients (31.6%) and minor changes in 17 (33.3%) comparing the results of the transesophageal and transthoracic approaches. It was also assessed the influence of the result on the clinical management of the patient: in 32 cases (62.8%) there were a significant change in the treatment; in 5 patients (9.8%) cardiac surgery was prompted by echocardiography. Only in 3 patients hypertensive reactions and tachycardia were detected, without posterior consequences.
Transesophageal echocardiography can be safely performed and has a definite role in the diagnosis (showing sometimes non-suspected abnormalities) and management of non-cardiological critically ill patients.
经食管超声心动图在评估重症心脏病患者中的作用已广为人知。然而，对于非心脏病重症患者，其在这方面的应用经验较少。
为评估该方法的实用性和安全性，我们分析了51项与入住本院综合重症监护病房患者相关的研究。47例患者（92%）接受机械通气，24例患者（47%）可进行血流动力学变量的连续评估。
入院时最常见的诊断为脓毒症（23.5%）和休克状态（17.6%）。检查指征包括：怀疑心内膜炎（15例）、血流动力学不稳定（11例）、心脏栓子来源（10例）、怀疑心脏压塞（4例）、怀疑主动脉夹层（4例）以及其他原因7例。该研究在31例（60.8%）中证实了临床怀疑，在15例（29.4%）中排除了怀疑，并在5例患者（9.8%）中确立了新的、未被怀疑的诊断。比较经食管和经胸检查方法的结果，16例患者（31.6%）有重大诊断改变，17例患者（33.3%）有轻微改变。还评估了结果对患者临床管理的影响：32例（62.8%）治疗有显著改变；5例患者（9.8%）因超声心动图检查而促使进行心脏手术。仅3例患者检测到高血压反应和心动过速，无后续不良后果。
经食管超声心动图检查可安全进行，在非心脏病重症患者的诊断（有时显示未被怀疑的异常）和管理中具有明确作用。
