经食管超声心动图.docVIP

经食管超声心动图经食管超声心动图（transesophageal echocardiography, TEE）是将超声探头置入食管内，从心脏的后方向前近距离探查其深部结构，避免了胸壁、肺气等因素的干扰，故可显示出清晰的图像，提高对心血管疾病诊断的敏感性和可靠性，便于进行心脏手术中的超声监测与评价。 第二节 适应症及并发症 适应症（一）TEE在诊断中的应用 TEE主要用于常规经胸超声检查成像困难或者有关结构显示不够满意、致使诊断难以明确的各种心脏或大血管疾病患者，包括： 1、各种先天性心血管畸形； 2、心脏瓣膜疾病，如瓣膜狭窄、关闭不全、脱垂及腱索断裂等； 3、各种人造瓣膜的功能评价； 4、感染性心内膜炎； 5、主动脉疾病，如主动脉瘤、夹层动脉瘤、主动脉窦瘤破裂； 6、心脏占位性病变，尤其是左心房和左心耳血栓形成、云雾状回声和黏液瘤等。 7、冠状动脉疾病，如冠状动脉狭窄、局限性扩张或冠状动脉瘘等； 8、肺静脉血流的观察与测定等。 （二）术前TEE评价 （三）术中TEE监测 1.?绝对禁忌症较少，包括：有咽喉和食道梗阻、活动性的上消化道出血、已知或可疑的内脏穿孔、颈椎不稳定。 2.?相对的禁忌症包括：食道变异或可疑的食道憩室，严重颈关节炎，口咽部的病变，，。先用2%利多卡因溶液喷雾受检者咽部，进行充分的局部麻醉；随后患者取左侧卧位，枕头高度适中，使头部与躯干部的中轴成一直线。左口角应稍低，以利唾液自动流出。将超声耦合剂涂抹于换能器及管体前段的表面，以增加其润滑性，减少插管时对咽喉部的机械刺激。探头前端前倾呈弧状，以适应咽部与食管的曲度。一般换能器面朝前方，以便其对准心脏结构扫描。步骤先放置撑口器，将探头通过撑口器送入受检者口中，探头顶端到达咽部时令其做吞咽动作，在咽部扩展的瞬间，轻巧、迅速、柔和地将探头推进并送入食管。 and work. Many classes established the duty monitor system, let every students have class member services and for the class the opportunity to work, this is not a fixed position of the monitor system of rotation, which not only can let the monitor on duty in a days work for class service work, also can let students know more of the solution in the class, every student can learn. And the class cadre conference held regularly. Pay attention to class and major incidents in the recent, Concerned about the class need to help students and make the class committee work plan and the new division.A good class of 4..Each class in the formulation of the goal, the class of the Convention at the same time, pay more attention to the class a good class construction work class. The class construction is the pillar industry of class education work, to perform the correct public opinion guide guide, schools, teachers education intent can be more smoothly issued, strict execution. Discipline, clean environment, learning atmosphere, most students with emotional attachment and collective identity, and consciously safeguard the collective honor and so on. We must first establish a collective concept, the formation of we