| 摘要: |
| 目的 本研究在连续性开展无痛TEE的基础上,监测及评估无痛TEE的安全性、患者舒适度及诊疗效果并与普通TEE进行比较,明确其在临床上的应用价值。方法 普通TEE组116例(男性67例,女性49例,平均年龄47±15岁),无痛TEE组80例(男性37例,女性43例,平均年龄44±16岁),排除标准及纳入标准遵照2013年美国超声心动图学会(ASE)指南,所有患者知情同意,由高年资医师完成扫查与诊断。监测与评估指标如下：(1)生命体征监测(2)记录TEE检查失败率、一次性插管成功率、检查时间以及并发症；(3)评估图像满意度；(4)患者舒适度VAS评估。 结果 无痛TEE组ASA评分高于常规TEE组(P＜0.05),左室射血分数LVEF低于常规TEE组(P＜0.05),两组间临床适应症分布具有显著性差异(P＜0.05)。普通TEE组检查中的心率、收缩压和舒张压均显著高于检查前基础状态(P＜0.05),检查后较检查中减低(P＜0.05)仍稍高于检查前基础状态;无痛TEE患者检查中心率、收缩压与舒张压均较检查前稍降低(P＜0.05),但检查后升高且与检查前基础状态无显著性差异。无痛TEE组均成功放置食道超声探头,普通TEE组6例未能完成常规TEE置管；无痛TEE组一次性插管成功率显著高于普通TEE组(无痛VS普通：87.5% VS 75.9%；P＜0.05),检查时间显著长于普通TEE组(无痛VS普通：13.2±4.4min VS 5.3±2.0min；P＜0.05)；无痛TEE组中98.8%的病例图像清晰满意,而普通TEE组中仅65.5%的图像满意(P＜0.05)。无痛TEE组VAS分值显著低于普通TEE组VAS分值(无痛VS普通：0.4±0.8 VS 3.3±1.7; P＜0.01),患者再次行TEE检查的意愿显著高于普通TEE组(无痛VS普通：92.5% VS 51.7%；P＜0.01)。结论：无痛TEE是一项安全、有效的检查方法,与普通TEE相比较,适用于病情更重的患者,能够为患者提供更为舒适的检查体验,有利于获取全面、优质的图像资料,使其更好地服务于临床诊疗评估。 |
| 关键词: 经食道超声心动图 无痛 麻醉 |
| DOI： |
| 投稿时间：2019-11-14修订日期：2019-11-14 |
| 基金项目: |
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| A Comparative Study of Safety and Effectiveness in Sedated and Conventional Transesophageal Echocardiography |
| Zhu Ying,Liu Yani,Deng Youbin,Yu Honghui,Tan Juan,Bei Bin,Cao Lizhu,Zhuo Xiao,Sun Ruiying |
| () |
| Abstract: |
| ABSTRACT Objective This study was performed to monitor and evaluate the safety, patient comfort and efficacy of sedated transesophageal echocardiography (TEE), which was compared with conventional TEE only with topical oropharyngeal anaesthesia. Methods Between August 2018 to August 2019, 116 patients (67 males with an average age of 47±15 years) referred to conventional TEE and 80 patients (37 males with an average age of 44±16 years) referred to sedated TEE were included. The exclusion and inclusion criteria were complied with 2013 TEE guideline of ASE. During the whole examination, the following indicators were monitored and recorded, 1) heart rate, blood pressures and oxygen saturation changes; 2) success rate of one-time intubation, examination time and complications ; 3) image satisfaction; and 4) the level of patient discomfort. The results of the two groups were compared and statistically analyzed．Results In sedated TEE group, ASA score was higher than that of conventional TEE group (P<0.05), LVEF was lower than that of conventional TEE group (P<0.05). There was significant difference in clinical indication distribution between the two groups (P<0.05). In the conventional TEE group, the heart rate and blood pressures increased significantly during examination(P<0.05), which were reduced after exmamination but still slightly higher than those before examination. In the sedated TEE patients, the heart rate, systolic and diastolic blood pressures during examination were reduced compared with baseline pressures (P＜0.05). However, there was significant increase of the heart rate and blood pressures after examination (P＜0.05). The success rate of one-time intubation in sedated TEE group was higher than that in conventional TEE (Sedated VS Conventional: 87.5% VS 75.9%, P＜0.05), the examination time was significantly longer than that of the conventional TEE group (Sedated VS Conventional: 13.2±4.4min VS 5.3±2.0min, P＜0.05). 98.8% cases in sedated TEE group had satisfactory images, while only 65.5% patients in conventional TEE . The VAS score in sedated TEE group was significantly reduce compared with conventional TEE group (0.4±0.8 VS 3.3±1.7; P＜0.01). And the willing to receive TEE examination again in sedated group was significantly higher than that of the conventional TEE group (Sedated VS Conventional: 92.5% VS 51.7%; P＜0.01). Conclusions Sedated TEE is a safe and effificient examination. Compared with conventional TEE, it is suitable for patients with more serious conditions, and can obviously improve the patient comfort and image qualities during TEE, which contributed to the precise clinical diagnosis and treatment evaluation. |
| Key words: transesophageal echocardiography sedation anesthesia |
