CAJ | 학술논문

目的评价经食管超声心动图(TEE)鉴别心腔内空气和脂肪栓子的可行性.方法雄性梅白猪16只,体重40～48 kg,随机分为脂肪组和空气组,每组8只.空气组先经股静脉依次注射空气0.0025、0.0125、0.025、0.05和0.1 nl/kg,间隔30 min,然后依次注射空气0.2、0.5和1 ml/kg,随后每次增加l ml/kg,注射速率为2 ml/s,间隔60 min,直至心跳停止;脂肪组先经股静脉依次注射脂肪0.0025、0.005、0.0125和0.025 ml/kg,间隔30 min,随后依次注射脂肪0.05和0.1 ml/kg,随后每次增加0.1 ml/kg,注射速率为2 ml/s,间隔60 min,直至心跳停止.记录空气栓子和脂肪栓子的致死量,行TEE栓子回声模式分级,观察反常栓塞和皮肤出血点的发生情况.结果脂肪组TEE示心腔内为细粒状回声,注射剂量越大越密集,回声模式1或2级;空气组TEE示心腔内为强回声团,注射空气量越多,回声团越大,空气量≥O.5 ml/kg后,回声团直径>5咖,回声模式3级.注射大剂量空气(≥O.5ml/kg)和致死剂量脂肪后,脂肪组TEE栓子回声模式分级低于空气组(P<0.01).脂肪组反常栓塞和皮肤出血点的发生率均高于空气组(P<O.01).结论 TEE可鉴别心腔内空气栓子和脂肪栓子.
목적 평개경식관초성심동도(TEE)감별심강내공기화지방전자적가행성.방법 웅성매백저16지,체중40～48 kg,수궤분위지방조화공기조,매조8지.공기조선경고정맥의차주사공기0.0025、0.0125、0.025、0.05화0.1 nl/kg,간격30 min,연후의차주사공기0.2、0.5화1 ml/kg,수후매차증가l ml/kg,주사속솔위2 ml/s,간격60 min,직지심도정지;지방조선경고정맥의차주사지방0.0025、0.005、0.0125화0.025 ml/kg,간격30 min,수후의차주사지방0.05화0.1 ml/kg,수후매차증가0.1 ml/kg,주사속솔위2 ml/s,간격60 min,직지심도정지.기록공기전자화지방전자적치사량,행TEE전자회성모식분급,관찰반상전새화피부출혈점적발생정황.결과 지방조TEE시심강내위세립상회성,주사제량월대월밀집,회성모식1혹2급;공기조TEE시심강내위강회성단,주사공기량월다,회성단월대,공기량≥O.5 ml/kg후,회성단직경>5가,회성모식3급.주사대제량공기(≥O.5ml/kg)화치사제량지방후,지방조TEE전자회성모식분급저우공기조(P<0.01).지방조반상전새화피부출혈점적발생솔균고우공기조(P<O.01).결론 TEE가감별심강내공기전자화지방전자.
Objective To evaluate the feasibility of using transesophageal echocacdingraphy (TEE) to differentiate air emboli from fat emboli in cardiac chambers. Methods Sixteen male domestic pigs weighing 40-48 kg were randomly allocated to air embolism group ( n = 8 ) and fat embolism group ( n = 8 ). The animals were anesthetized with intramuscular ketamine 10 mg/kg. Anesthesia was maintained with phenobarbital 10 mg·kg-1 · h-1. Tracheal intubatiou was facilitated with vecuronium 0.2 mg/kg. The animals were mechanically ventilated with O2 . PETCO2 was maintained at 33-35 mm Hg. Right femoral artery and vein and internal jugular vein were cannulated. MAP, CVP, SPO2, PET CO2, lung compliance (CL), airway pressure (Paw) and the difference between O2 concentration in inspired and expired air [O2(I-E)>] were monitored. In fat embolism group allogeneic fat was heated and turned into fluid which was cooled down to 37-40℃. The probe of TEE was inserted into esophagus. In air embolism group air 0.0025, 0.005,0.0125, 0.025, 0.05 and 0.1 ml/kg were injected sequentially via femoral vein at 30 rain intervals, then air 0.2, 0.5, 1.0 ml/kg (in increments of 1.0 ml/kg each time) were injected at 60 min intervals until development of cardiac arrest. In fat embolism group liquidized fat 0.0025, 0.005, 0.0125, and 0.025 ml/kg were injected iv sequentially at 30 min intervals then 0.05, 0.1 ml/kg (in increments of 0.1 ml/kg each time) were injected iv at 60 rain intervals until development of cardiac arrest.The amount of air / liquidized fat injected immediately before cardiac arrest was recorded. The TEE echo pattern of the emboli was graded (0=no embeli, 1=fine emboli, 2=diameter of emboli < 5 mm, 3 = diameter of emboli > 5 mm). The paradoxical embolism and petechiac were observed. Results When larger amount of air ( > 0.5 ml/kg) was injected, the echo pattern reached grade 3; when lethal amount of liquidized fat was injected the echo pattern grade was lower (1-2). The incidence of paradoxical embolism and petechiae was significantly lower in air embolism group than in fat embolism group. Conclusion. TEE can be used to differentiate air emboli from fat emboli in cardiac chambers.