Hemodynamic Evaluation of Anesthetics and Positioning by Transesophageal Echocardiography

在获得每位患者的知情同意后，我们进行了如下研究。应用经食管超声心动图（TEE）评价泮库溴铵（PB）和维库溴铵（VB）对手术患者左心室功能的影响。PB引起心率（HR）、血压（BP）和心脏指数（CI）显著升高。由于脑卒中容积指数（SVI）没有显著增加，HR的增强可能导致CI的增加。PB对左心室收缩功能无影响。VB未引起血流动力学性能的明显改变。我们用TEE研究俯卧位对心功能的影响。俯卧位左室容积（LVV）明显降低，收缩期肺静脉流速（PVFV）和肺静脉流速时间积分（PVVTI）明显降低，舒张期PVFV和PVVTI明显升高。俯卧位SVI和CI无明显变化。这些变化可能是由于下腔静脉压迫导致静脉回流减少，以及俯卧位时胸内压力增加导致左心室顺应性降低所致。我们进行了这项研究，以估计冠状动脉旁路移植术（TEE）期间冠状动脉窦血流（CSF）的变化。冠脉搭桥后脑脊液的流速和VTI均显著升高，这可能与冠脉搭桥后冠状动脉血流增加有关。本研究结果表明，这种新的围手术期评价方法是可行的。

After obtaining informed consent from each patient, we studied as follows.1.We evaluated effect of pancuronium bromide (PB) and vecuronium bromide (VB) on the left ventricular function of surgical patients using the transesophageal echocardiography (TEE). PB caused significant increases in Heart rate (HR), blood Pressure (BP) and cardiac index (CI). The enhanced HR probably caused the increase in CI,because there was no singificant increase in stroke volume index (SVI).PB had no effect on left ventricular systolic functions. VB didn't cause any significant changes in hemodynamic performance.2.We investigated effect of prone positioning on cardiac function using TEE.In the prone position, there was significant reduction in left ventricular volume (LVV), diminishment of systolic pulmonary venous flow velocity (PVFV) and pulmonary venous velocity time integral (PVVTI) and enhancement of diastolic PVFV and PVVTI.SVI and CI did not change significantly in the prone position. These changes were probably due to a decrease in the venous return due to inferior vena caval compression, and decreased left ventricular compliance due to increased intra-thoracic pressure in the prone position.3.We performed this study to estimate changes in coronary sinus flow (CSF) during coronary artery bypass grafting (CABG) by TEE.All velocities and VTI of CSF increased significantly after CABG,which was probably due to increased coronary blood flow after CABG.The results of this study indicate the feasibility of this new perioperative method of CABG evaluation.