TEE在心脏手术中的应用1.ppt

M型法 主动脉Doppler血流频谱 肺动脉Doppler血流频谱 降主动脉PW血流 舒张功能监测 PAWP 二尖瓣血流频谱 E/A 彩色M型多谱勒（color M-mode Doppler, CMD） 组织多谱勒显像（tissue Doppler imaging, TDI) 声学定量(acoustic quantification/automatic borderline determination, AQ) Normal transmitral flow pattern. Pulse wave Doppler profile of normal transmitral flow during diastole sampled at the tip of the mitral leaflets using the apical four-chamber view. Note the early (E) and atrial (A) velocities representing early and late filling. DT, deceleration time. Color M-mode flow propagation velocity. Color M-mode propagation velocities in patient with normal (left) and abnormal (right) diastolic function. Vp, color M-mode color flow propagation velocity (normal Vp[cm/s] 45; diastolic dysfunction 45). 心肌缺血监测 节段性室壁运动异常（SWMA ） 左房压评估 脏器灌注监测 可对腹主动脉、肾动脉、脾动脉和颈总动脉的血管内径和血流量进行测量，为术中脏器保护研究和临床应用提供依据。 手术效果即刻评价 瓣膜成形术 二尖瓣前叶裂伴大量返流 二尖瓣成形术后 TEE在心脏手术中的应用 Transesophageal Echocardiography monitoring in cardiac surgery 魏蔚 心脏手术中应用TEE的优势 直接观察左室前负荷 左室收缩和舒张功能的监测 早期监测心肌缺血 补充诊断及对手术效果的评估 指导和评价导管的放置 麻醉医师与术中TEE In 2019, the House of Delegates of the American Society of Anesthesiologists approved the “Practice Guidelines for Perioperative Transesophageal Echocardiography.” In current practice in the UK, 90% are performed not by cardiologists but, by cardiac anaesthetists. J. D. Kneeshaw. Transoesophageal echocardiography (TOE) in the operating room. British Journal of Anaesthesia 97 (1): 77–84 (2019) 术中TEE放置的指征 Category1:TEE is useful in improving the outcome. Category2:TEE might be useful. Category3:TEE is infrequently useful. For adult patients without contraindications, TEE should be used in all open heart (e.g., valvular procedures) and thoracic aortic surgical procedures and should be considered in coronary artery bypass graft surgeries to: (1) confirm and refine the preoperative diagnosis, (2) detect new or unsuspected pathology, (3) adjust the anesthetic and surgical plan accordingly, (4) assess the results of surgical interventio