Suriani R J, Cutrone A, Feierman D, Konstadt S
Department of Anesthesiology, Mount Sinai Medical Center, New York, NY, USA.
J Cardiothorac Vasc Anesth. 1996 Oct;10(6):699-707. doi: 10.1016/S1053-0770(96)80193-5.
To investigate the safety, value, and impact of transesophageal echocardiography during liver transplantation.
Retrospective.
University teaching hospital.
The medical records of 346 patients and the videotapes of 100 intraoperative transesophageal echocardiography examinations were reviewed.
Transesophageal echocardiography was indicated for intraoperative monitoring in 62 patients, 41 of whom had pertinent findings, and for diagnostic purposes in 38 patients, 14 of whom had the expected diagnosis verified. Thirty-one patients had no intraoperative findings. Information that would not have been detected intraoperatively by other means included intracardiac defects, the potential for transpulmonary air passage, valvular regurgitation, the presence or absence of ventricular dysfunction, and embolization occurring at allograft reperfusion. Unanticipated findings during the initial transesophageal echocardiography examination as well as evaluation of intraoperative events resulted in a major impact on patient management in 11% of patients. Preoperatively, 64 patients had a prothrombin time greater than 14 seconds; 56 had a platelet count less than 100,000/mm3; and 23 had esophageal varices, 7 of whom had not had variceal sclerotherapy. Two patients had a complication possibly caused by transesophageal echocardiography (sinus bradycardia and upper gastrointestinal bleeding). No patient experienced documented variceal hemorrhage, esophageal or gastric perforation, and/or oropharyngeal trauma.
It appears that transesophageal echocardiography can be performed safely in patients undergoing liver transplantation, is efficacious in rapidly disclosing new information and monitoring during periods of hemodynamic instability, and may have a significant impact on intraoperative patient management during liver transplantation.
探讨经食管超声心动图在肝移植术中的安全性、价值及影响。
回顾性研究。
大学教学医院。
回顾了346例患者的病历及100例术中经食管超声心动图检查的录像带。
62例患者术中应用经食管超声心动图进行监测，其中41例有相关发现；38例用于诊断目的，其中14例确诊。31例患者术中未发现异常。其他方法术中无法检测到的信息包括心内缺损、经肺空气通道的可能性、瓣膜反流、心室功能障碍的存在与否以及移植肝再灌注时发生的栓塞。初次经食管超声心动图检查期间的意外发现以及术中事件的评估对11%的患者的治疗管理产生了重大影响。术前，64例患者凝血酶原时间大于14秒；56例血小板计数低于100,000/mm³；23例有食管静脉曲张，其中7例未接受过曲张静脉硬化治疗。2例患者出现可能由经食管超声心动图引起的并发症（窦性心动过缓和上消化道出血）。无患者发生记录在案的曲张静脉出血、食管或胃穿孔和/或口咽创伤。
经食管超声心动图似乎可在肝移植患者中安全进行，在血流动力学不稳定期间能有效快速披露新信息并进行监测，且可能对肝移植术中患者的治疗管理产生重大影响。
