Research progress on the clinical application of echocardiography in acute and critical diseases

doi:10.3877/cma.j.issn.2095-655X.2017.03.002

Abstract

Abstract:

Increasing, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are being used to monitor hemodynamics in critically ill patients.Among patients with life-threatening illnesses such as sepsis, respiratory failure, congestive heart failure (CHF), shock, traumatic injuries as well as patients with signicant respiratory and cardiac diseases undergoing noncardiac surgery and high-risk noncardiac procedures, TTE and TEE play an important role in monitoring and decision making.Echocardiography has the advantages of portability, noninvasive, reproducibility.Particularly, it can be performed at the bed-side for avoiding patients' displacements, and can provide real-time transcendental information for vital decisions.With the application of echocardiography in clinical, many studies have confirmed its value of the diagnosis, the evaluation of treatment, and the advantage of repeated monitoring of hemodynamics.

Key words: Echocardiography, Emergencies, Critical illness, Application

Jingjing Yang, Mei Zhang, Yun Zhang. Research progress on the clinical application of echocardiography in acute and critical diseases[J]. Chinese Journal of Diagnostics(Electronic Edition), 2017, 05(03): 149-153.

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References 23

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监测指标的意义	检查方法	参考值
二尖瓣峰值血流速度和心肌舒张速度峰值的比值E/e′提示LAP	脉冲波多普勒组织多普勒	E/e′<8；正常LVEF提示LAP正常； E/e′≥13；正常LVEF提示LAP升高； E/A>2；DT<150 ms；降低的LVEF提示LAP增高； E/A<1且E<50 cm/s；降低的LVEF提示LAP正常
下腔静脉大小/塌陷度提示RAP	二维超声	直径≤2.1 cm；塌陷度>50%提示RAP 0～5 mmHg；直径>2.1 cm；塌陷度>50%提示RAP 5～10 mmHg；直径>2.1 cm；塌陷度<50%提示RAP 10～20 mmHg
左室右室心腔大小、面积、容积提示血管内容量的状态、功能	二维超声	LVIDD 4.2～5.9 cm(男)，3.9～5.3 cm(女)； LVEDV 62～150 ml (男)，46～106 ml(女)； LVESV 21～61 ml(男)，14～42 ml (女)； FAC≥ 35%
左室流出道每搏距离提示血管内容量的状态	二维超声脉冲波多普勒	正常值：VTI>18 cm
PASP提示右心血流动力学状态	脉冲波多普勒连续波多普勒	正常值：PASP<35 mmHg
TAPSE和RV s′提示扩容治疗时的右室功能	M型超声组织多普勒	正常值：TAPSE≥16 mmRV s′≥ 10 cm/s

监测指标的意义	检查方法	参考值
二尖瓣峰值血流速度和心肌舒张速度峰值的比值E/e′提示LAP	脉冲波多普勒组织多普勒	E/e′<8；正常LVEF提示LAP正常； E/e′≥13；正常LVEF提示LAP升高； E/A>2；DT<150 ms；降低的LVEF提示LAP增高； E/A<1且E<50 cm/s；降低的LVEF提示LAP正常
下腔静脉大小/塌陷度提示RAP	二维超声	直径≤2.1 cm；塌陷度>50%提示RAP 0～5 mmHg；直径>2.1 cm；塌陷度>50%提示RAP 5～10 mmHg；直径>2.1 cm；塌陷度<50%提示RAP 10～20 mmHg
左室右室心腔大小、面积、容积提示血管内容量的状态、功能	二维超声	LVIDD 4.2～5.9 cm(男)，3.9～5.3 cm(女)； LVEDV 62～150 ml (男)，46～106 ml(女)； LVESV 21～61 ml(男)，14～42 ml (女)； FAC≥ 35%
左室流出道每搏距离提示血管内容量的状态	二维超声脉冲波多普勒	正常值：VTI>18 cm
PASP提示右心血流动力学状态	脉冲波多普勒连续波多普勒	正常值：PASP<35 mmHg
TAPSE和RV s′提示扩容治疗时的右室功能	M型超声组织多普勒	正常值：TAPSE≥16 mmRV s′≥ 10 cm/s

临床情况	监测指标
低血压	IVC塌陷指数；局部室壁动度；被动直腿抬高试验时LVOT VTI
充血性心力衰竭	IVC塌陷指数；二尖瓣E/e′；二尖瓣血流E/A，EDT，右心室s′；TAPSE；局部室壁动度
败血症	IVC塌陷指数；局部室壁动度；LVIDD, LVIDS
肺栓塞可能	IVC塌陷指数；右心室s′；局部室壁动度；TAPSE; PASP；RVOT VTI；RVIDD/LVIDD
心包积液/填塞	心包积液量；右心室舒张期塌陷；IVC塌陷指数
人工瓣膜	跨瓣压力阶差
创伤	IVC塌陷指数；心包积液量；局部室壁动度；LVIDD, LVIDS
烧伤	IVC塌陷指数；二尖瓣E/A，E/e′；LVIDD, LVIDS
主动脉阻断术	局部室壁动度；LVIDD, LVIDS
肝移植	局部室壁动度；右室s′；右室腔内栓子；TAPSE；LVIDD, LVIDS
肾移植	局部室壁动度；右室s′；二尖瓣E/A，E/e′，右室腔内栓子；LVIDD, LVIDS；TAPSE
矫形/脊柱/神经手术	右室s′；二尖瓣E/e′；右室腔内栓子；TAPSE

临床情况	监测指标
低血压	IVC塌陷指数；局部室壁动度；被动直腿抬高试验时LVOT VTI
充血性心力衰竭	IVC塌陷指数；二尖瓣E/e′；二尖瓣血流E/A，EDT，右心室s′；TAPSE；局部室壁动度
败血症	IVC塌陷指数；局部室壁动度；LVIDD, LVIDS
肺栓塞可能	IVC塌陷指数；右心室s′；局部室壁动度；TAPSE; PASP；RVOT VTI；RVIDD/LVIDD
心包积液/填塞	心包积液量；右心室舒张期塌陷；IVC塌陷指数
人工瓣膜	跨瓣压力阶差
创伤	IVC塌陷指数；心包积液量；局部室壁动度；LVIDD, LVIDS
烧伤	IVC塌陷指数；二尖瓣E/A，E/e′；LVIDD, LVIDS
主动脉阻断术	局部室壁动度；LVIDD, LVIDS
肝移植	局部室壁动度；右室s′；右室腔内栓子；TAPSE；LVIDD, LVIDS
肾移植	局部室壁动度；右室s′；二尖瓣E/A，E/e′，右室腔内栓子；LVIDD, LVIDS；TAPSE
矫形/脊柱/神经手术	右室s′；二尖瓣E/e′；右室腔内栓子；TAPSE

超声心动图监测指标	临床情况	有意义的变化(基于基线)
IVC塌陷指数	充血性心衰	>10%
	外伤	从<50%增加至>50%
	围手术期	从<50%增加至>50%
E/A	充血性心衰	从<1增大至1～2，乃至>2
左室收缩功能降低	围手术期	从<1增大至1～2，乃至>2
E/e′	充血性心衰	>8%
左室收缩功能正常	围手术期	从<8增大至9～14乃至≥15
LVOT VTI	充血性心衰	VTI>6%或SV>6%
左室流出道面积	围手术期	VTI>6%或SV>6%
PASP	肺栓塞；充血性心衰	>3%
PASP	围手术期	从<40增加至40～60乃至>60 mmHg
LVIDD；LVIDS	充血性心衰；围手术期	>8%
FAC	肺栓塞；围术期；肺高压；	右室FAC>10%
右室S′，TAPSE	左室辅助装置	右室s′>1.6 mm/s
右室S′，TAPSE	左室辅助装置	TAPSE>1.9 mm

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