实用老年医学

实用老年医学 ›› 2022, Vol. 36 ›› Issue (5): 441-444.doi: 10.3969/j.issn.1003-9198.2022.05.003

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经食道超声斑点追踪技术评估老年冠状动脉旁路移植术病人左心舒张功能的研究

龚婵娟, 桂波, 朱琳佳   

  1. 210029 江苏省南京市,南京医科大学第一附属医院麻醉与围术期医学科(龚婵娟,朱琳佳);
    210024 江苏省南京市,江苏省省级机关医院麻醉科(桂波)
  • 收稿日期:2022-03-10 出版日期:2022-05-20 发布日期:2022-05-26
  • 通讯作者: 朱琳佳,Email:zhulinjia2010@163.com
  • 作者简介:朱琳佳 主治医师

Intraoperative assessment of left-ventricular diastolic function by transesophageal speckle tracking echocardiography in elderly patients undergoing off-pump coronary artery bypass graft surger

GONG Chan-juan, GUI Bo, ZHU Lin-jia   

  1. GONG Chan-juan, ZHU Lin-jia. Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China;
    GUI Bo. Department of Anesthesiology, Jiangsu Province Official Hospital, Nanjing 210024, China
  • Received:2022-03-10 Online:2022-05-20 Published:2022-05-26

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摘要： 目的 探讨经食道超声斑点追踪技术对老年不停跳冠状动脉旁路移植术(off-pump coronary artery bypass graft, off-pump CABG)病人血运重建前后左心舒张功能的评价作用。 方法 选择2020年5月1日至12月30日行off-pump CABG的病人49例,分别在T0(探头放置后5 min)、T1(冠状动脉血运重建后30 min)2个时间点,使用彩色多普勒超声诊断仪留取连续3个心动周期经食道中段四腔心、两腔心、三腔心图像,并转存入工作站描记等容舒张期应变率(strain rate during isovolumic relaxation, SRIVR)、舒张早期应变率(strain rate during early diastole, SRe)以及舒张晚期应变率(strain rate during late diastole, SRa)。比较冠脉血运重建前后病人左心舒张功能变化。分析各舒张时期应变率指标(strain based indices, SBIs)与肺毛细血管楔压(pulmonary capillary wedge pressure, PCWP)的相关性及SRIVR、SRe、SRa预测PCWP增高的诊断效能。 结果 冠脉血运重建后,病人SRIVR与SRa明显改善(P<0.05)。T0、T1时间点的SRIVR与PCWP均呈负相关(r=-0.78、-0.72, 均P<0.001);T0与T1时间点 SRIVR预测PCWP≥12 mmHg的AUC分别为0.88与0.89。 结论 经食道超声斑点追踪技术检测舒张时期应变率指标可以早期、敏感、准确地反映off-pump CABG老年病人血运重建后左心舒张功能变化,具有良好的临床应用前景。

关键词: 经食道超声心动图, 斑点追踪技术, 不停跳冠状动脉旁路移植术, 等容舒张期应变率, 老年人

Abstract: Objective To explore the evaluation of left-ventricular diastolic function by transesophageal speckle tracking echocardiography after revascularization in the elderly patients undergoing off-pump coronary artery bypass grafting (off-pump CABG). Methods A total of 49 elderly patients undergoing off-pump CABG were recruited. Transesophageal echocardiography examination was performed at T0 (5 min after placement of the transesophageal echocardiography probe) and T1 (30 min after revascularization). The four-, two-, and three-chamber views were obtained for 3 cardiac cycles, and then copied to a Philips QLab workstation. Strain rate during isovolumic relaxation (SRIVR), strain rate during early diastole (SRe) and strain rate during late diastole (SRa) were analyzed. The changes of left-ventricular diastolic function after coronary revascularization were compared. The correlation between strain rate-based indices (SBIs) and pulmonary capillary wedge pressure (PCWP) was analyzed,and the predictive ability of SRIVR,SRe and SRa for the increase of PCWP was also evaluated. Results SRIVR and SRa were significanly improved after revascularization (both P＜0.05). At T0 and T1, SRIVR was negatively correlated with PCWP (r=-0.78, -0.72,all P＜0.001). At T0 and T1, SRIVR showed a strong ability to predict PCWP ≥ 12 mmHg (AUC=0.88, 0.89). Conclusions Strain based indices were more sensitive and accurate predictors for the increase of PCWP, which has a good prospect in clinical application.

Key words: transesophageal echocardiography, speckle tracking imaging, off-pump coronary artery bypass graft, strain rate during isovolumic relaxation, aged

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