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目的探讨应用全方向M型超声心动图(OME)在二尖瓣置换术(MVR)手术开始前及术后即刻进行监测,对其左室心肌功能评估的价值。方法选取2015年1月至2016年10月二尖瓣狭窄并关闭不全实施MVR的患者61例,根据心电图结果分为Ⅰ组(窦性心律)24例及Ⅱ组(房颤心律)37例。采用OME于MVR手术开始前和手术结束拔升主动脉插管前全灌注时测量患者室间隔、左室侧壁、前壁、下壁各位点收缩期最大位移、峰值速度及达峰时间变化情况,以为手术者和麻醉师提供对患者左室心肌功能实时评估的依据。结果 (1)收缩期最大位移:术后即刻Ⅱ组各位点及Ⅰ组室间隔、左室前壁位点收缩期最大位移均大于术前,差异有统计学意义(P<0.01,P<0.05);(2)收缩期峰值速度:术后即刻Ⅱ组各位点及Ⅰ组室间隔、左室前壁位点收缩期峰值速度均高于术前,差异有统计学意义(P均<0.05);(3)收缩期达峰时间:术后即刻Ⅱ组各位点及Ⅰ组室间隔、左室前壁位点收缩期达峰时间均小于术前,差异有统计学意义(P<0.01,P<0.05)。结论应用OME系统实时监测,可为MVR术后即刻了解患者左心室各节段室壁运动的信息、评估其术后左室心肌功能提供参考。
Objective To investigate the value of omnidirectional M-mode echocardiography (OME) in assessing left ventricular myocardial function before and after mitral valve replacement (MVR) surgery. Methods Sixty-one patients with mitral stenosis and incomplete MVR were enrolled from January 2015 to October 2016. According to the results of electrocardiogram, 24 patients were divided into group Ⅰ (sinus rhythm) and 37 patients with group Ⅱ (atrial fibrillation). OME was used to measure the maximal systolic displacement, peak velocity and peak time of ventricular septum, left ventricular wall, anterior wall and inferior wall at the time of complete perfusion before the start of MVR and the end of operation. , To provide a basis for real-time assessment of left ventricular myocardial function in patients and anesthesiologists. Results (1) The maximum systolic displacement: The maximum systolic displacement at each site of group Ⅱ and group Ⅰ and the anterior wall of group Ⅰ were significantly higher than those before operation (P <0.01, P <0.05) ); (2) The peak systolic velocity: The peak systolic velocity at each site of group Ⅱ and groupⅠ and the anterior systole of left ventricle were significantly higher than those before operation (all P <0.05) ; (3) Peak time of systole: The peak time of systolic phase in group Ⅱ and group Ⅰ was significantly shorter than that in group Ⅰ (P <0.01, P <0.05). Conclusion Real-time OME system monitoring can provide a reference for understanding the left ventricular wall motion in patients immediately after MVR and assessing their postoperative left ventricular myocardial function.