Bergquist B D, Leung J M, Bellows W H
Department of Anesthesia, University of California, San Francisco 94115, USA.
Anesth Analg. 1996 Jun;82(6):1132-8. doi: 10.1097/00000539-199606000-00006.
Transesophageal echocardiography (TEE) is increasingly used intraoperatively as a monitor of ventricular function and volume. Despite its increasing use, whether data from TEE monitoring can be interpreted accurately on-line in real-time is unknown. We studied the performance of five community-based, full-time cardiac anesthesiologists during 75 surgical procedures in which biplane TEE monitoring was used. Every 10 min intraoperatively, each anesthesiologist evaluated the video cine loop display of echocardiographic images to provide a real-time visual estimate of left ventricular ejection fraction area (EFA) and left ventricular filling at the level of the short axis and to assess regional wall-motion of the short axis and transgastric longitudinal views using a predefined scoring system. The same video images were analyzed quantitatively off-line by two blinded investigators. Intraoperative real-time estimates of EFA correlated moderately with off-line quantification (r = 0.8, P = 0.0001). Of the 662 cine loops analyzed by both off-line and real-time techniques, 386 (55%) were within +/-5% of each other, 495 (75%) were within +/-10% of each other, 561 (85%) were within +/-15% of each other, and 617 (93%) were within +/-20% of each other. The overall sensitivity and specificity of real-time echocardiographic ischemia detection were both 76%. However, there was individual variation among the five anesthesiologists. Recognition of normal and severe regional wall-motion abnormality, such as akinesis, had more concordance between real-time and off-line analysis, 93% and 79%, respectively, than recognition of mild regional wall-motion abnormalities. Anesthesiologists can estimate EFA in real-time to within +/-10% of off-line values in 75% of all cases. Real-time identification of normal regional function is more accurate than identification of abnormal function, i.e., there is variability in quantifying the severity of regional dysfunction.
经食管超声心动图（TEE）在术中越来越多地用于监测心室功能和容量。尽管其使用越来越广泛，但TEE监测数据能否实时在线准确解读尚不清楚。我们研究了5名社区全职心脏麻醉医生在75例使用双平面TEE监测的外科手术中的表现。术中每10分钟，每位麻醉医生评估超声心动图图像的视频电影环显示，以实时视觉估计左心室射血分数面积（EFA）和短轴水平的左心室充盈情况，并使用预定义的评分系统评估短轴和经胃纵向视图的局部室壁运动。两名不知情的研究人员对相同的视频图像进行离线定量分析。术中EFA的实时估计与离线定量分析中度相关（r = 0.8，P = 0.0001）。在通过离线和实时技术分析的662个电影环中，386个（55%）彼此相差±5%以内，495个（75%）彼此相差±10%以内，561个（85%）彼此相差±15%以内，617个（93%）彼此相差±20%以内。实时超声心动图缺血检测的总体敏感性和特异性均为76%。然而，5名麻醉医生之间存在个体差异。与轻度局部室壁运动异常相比，正常和严重局部室壁运动异常（如运动不能）的识别在实时和离线分析之间的一致性更高，分别为93%和79%。在所有病例的75%中，麻醉医生可以实时估计EFA，使其与离线值相差±10%以内。正常局部功能的实时识别比异常功能的识别更准确，即量化局部功能障碍的严重程度存在变异性。
