目的：总结心律植入装置感染导线拔除术中急性并发症情况及术中监测要点，探讨经食道超声心动（Transesophageal echocardiography，TEE）在导线拔除术中监测中的作用。方法全麻下心律植入装置导线拔除手术56例，术中常规监测有创动脉压（IBP）、中心静脉压（CVP）、心率（HR）、血氧饱和度（SpO2）、呼末二氧化碳浓度（PET-CO2）。其中33例全麻后放置 TEE 探头进行实时监测。记录患者一般资料，术式选择和术中并发症情况，对比术前经胸超声心动图（Transthoracic Echocardiography，TTE）和术中 TEE 检查结果的相符情况。结果56例患者共拔除148根感染导线，经静脉拔除感染导线27例（48．2％）；通过杂交手术拔除感染导线17例（30．4％）；CPB 直视下拔除感染导线12例（21．4％）。有8例发生严重并发症，其中1例死亡。术中 TEE 发现1例心包压塞、4例三尖瓣损伤、1例因赘生物脱落造成肺栓塞，同时发现13例患者共计13处术中 TEE 检查和术前 TTE 检查结果不一致。结论全麻下电极导线拔除术严重并发症种类多，后果严重危及患者生命。应用有创动脉压、中心静脉压等监测手段，联合术中 TEE 监测可以快速发现并发症并及时明确原因。因此，术中 TEE 应作为此类手术的术中常规监测手段。%Objective To summarize the complications in endocardial lead extraction and our experience in the anes-thetic management.Discuss the role of transesophageal echocardiography (TEE)in intra-operative monitoring.Methods 56 cases of endocardial lead extraction,routine monitoring:IBP,CVP,HR,SpO2 ,PETCO2 ,33 cases of them were re-al-time monitoring by using TEE under general anesthesia.Recorded the patients’information,surgical method and complication.Compared the results of pre-transthoracic echocardiography(TTE)and intra-TEE.Results 148 infective leads were extracted from 56 patients.Transvenous lead extraction 27 cases(48.2%),hybrid thoracotomy 17 cases (30.4%),thoracotomy 12 cases(21.4%).8 serious complications were occurred,and 1 patient was dead.Intra-TEE had timely detection of 1 case of cardiac tamponade,4 cases of tricuspid valve injuried,1 case of vegetation dropped and caused pulmonary embolism.Compared to pre-TTE,TEE found 13 discrepancies.Conclusion There are several devas-tating complications in the endocardial lead extraction procedure which threaten to patient's life.Using TEE real-time monitoring combine with IBP,CVP,ect,could quickly find complications and ascertain the etiology in time.Consequent-ly,intraoperative TEE should be one of the routine monitoring methods in this operation.
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