目的 运用经食管超声对微创外科房间隔缺损封堵术中患者心功能及血流动力学的变化进行评价,探讨超声在微创外科房间隔缺损封堵术中的应用价值.方法 门诊筛查选择适合经微创外科封堵术治疗的房间隔缺损患者50例,于术中及手术前后对患者进行经食管超声和经胸超声心动图检查,分别测量左、右室心功能及血流动力学指标,并对手术前后结果进行对照比较.结果 术后左、右房室腔的径线与术前比较明显减小(P<0.05),右心室舒张末期容积(RVEDV)、右心室每搏输出量(RVSV)、右心排血量(CO)均较封堵前明显减小,左心室舒张末期容积(LVEDV)、每搏输出量(LVSV)及排血量(CO)均较封堵前增加,两者具有显著差异(P<0.05).而左心室收缩末期容积(LVESV)和右心室收缩末期容积(RVESV)以及左室和右室射血分数无显著变化.术后肺动脉瓣上最大血流速度、三尖瓣口E峰流速、三尖瓣反流最大流速及肺动脉收缩压与术前比较均显著减小(P<0.05),二尖瓣口E峰流速显著增大(P<0.05).结论 经食管超声可及时反映微创外科房间隔缺损封堵术前后患者心功能及血流动力学变化,为临床评价手术效果提供参考.%To evaluate cardiac function and hemodynamics in patients with minimal-invasive surgical device closure of secundum atrial septal defects by transesophageal echocardiography, and to discuss the value of transesophageal echocardiography. Methods Echocardiography tests were performed in fifty patients with secundum atrial septal defects undergone minimal-invasive surgical device closure. The values of certain parameters for cardiac function and hemodynamics were measured and analyzed preoperatively and postoperatively. Results After operation, the size of both right and left ventricle and atrium decreased ( P < 0. 05 ) , the right ventricular end diastolic volume ( RVEDV) , right ventricular stroke volume ( RVSV ) , right ventricular cardiac output ( RVCO ) decreased (P <0.05) , the left ventricular end diastolic volume (LVEDV) , left ventricular stroke volume (LVSV) , left ventricular cardiac output (LVCO) increased (P<0.05) , while the right ventricular end systolic volume (RVESV) , left ventricular end systolic volumern(LVESV) , and the ejection fraction (EF) of both right and left ventricle changed not much. The peak velocity, mean velocity and velocity time integral of pulmonary valve, the peak velocity of E wave in tricuspid valve, the peak velocity of tricuspid regurgitation and the pulmonary artery systolic pressure decreased (P<0.05) , while the peak velocity of E wave in mital valve increased (P<0.05). Conclusions Transesophageal echocardiography could be used as a tool in the evaluation of cardiac function and hemodynamics in patients with minimal-invasive surgical device closure of ecundum atrial septal defects.
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