CAJ | 학술논문

目的研究下腔静脉过滤器(rvcr)对骨水泥植入综合征(BCIS)的预防作用. 方法雄性绵羊10只,体质量25～30 kg,随机分为A组(不植入IVCF)和B组(植入IVCF)(n=5).麻醉后B组绵羊先在1250 mA透视机透视下,由颈内静脉经右心房在.肾下极5 cm处下腔静脉内植入IVCF.后将两组绵羊离断股骨颈扩髓腔,植入10 mL骨水泥,并逐渐增加髓腔内压,同期观测血压、心率、中心静脉压(CVP)和血气变化,心前区超声心动图动态实时显示心腔内情况改变.术毕分离肺脏,油红染色观察肺组织病理变化.结果 A组绵羊植入骨水泥后,当将股骨髓腔压力增加至120mm Hg时,右心房、右心室内即出现了点状不均匀回声,且随髓腔压力继续增加,点状回声变成大量雪花状叫声影,并伴血压、PaO2明显下降,25 min后收缩压下降至(80±11)mm Hg(P＜0.01),Pa02降至最低(P＜0.05),而心率、CVP进行性升高,血气分析示呼吸性酸中毒合并代谢性酸中毒,病理提示肺动脉血管内广泛散布大量脂肪栓子,血管腔阻塞;而B组绵羊在植入骨水泥后,在股骨髓腔内压升至400 mm№时尚未观察到右心腔出现脂肪栓子回声影,且血压、PaO2、心率、CVP较植入前未见明显降低或升高(P＞0.05),血气分析结果示通气正常,肺组织脂肪油红染色阴性. 结论 IVCF可有效预防骨水泥植入而引起的BCIS的发生.
목적 연구하강정맥과려기(rvcr)대골수니식입종합정(BCIS)적예방작용. 방법웅성면양10지,체질량25～30 kg,수궤분위A조(불식입IVCF)화B조(식입IVCF)(n=5).마취후B조면양선재1250 mA투시궤투시하,유경내정맥경우심방재.신하겁5 cm처하강정맥내식입IVCF.후장량조면양리단고골경확수강,식입10 mL골수니,병축점증가수강내압,동기관측혈압、심솔、중심정맥압(CVP)화혈기변화,심전구초성심동도동태실시현시심강내정황개변.술필분리폐장,유홍염색관찰폐조직병리변화.결과 A조면양식입골수니후,당장고골수강압력증가지120mm Hg시,우심방、우심실내즉출현료점상불균균회성,차수수강압력계속증가,점상회성변성대량설화상규성영,병반혈압、PaO2명현하강,25 min후수축압하강지(80±11)mm Hg(P＜0.01),Pa02강지최저(P＜0.05),이심솔、CVP진행성승고,혈기분석시호흡성산중독합병대사성산중독,병리제시폐동맥혈관내엄범산포대량지방전자,혈관강조새;이B조면양재식입골수니후,재고골수강내압승지400 mm№시상미관찰도우심강출현지방전자회성영,차혈압、PaO2、심솔、CVP교식입전미견명현강저혹승고(P＞0.05),혈기분석결과시통기정상,폐조직지방유홍염색음성. 결론 IVCF가유효예방골수니식입이인기적BCIS적발생.
Objective To observe the effect of inferior vena cava filter (IVCF) on prevention of bone cement implantation syndrome (BCIS). Methods Ten sheep were divided into 2 even groups, BCIS and LVCF intervention ones. First IVCF was implanted into the inferior vena cava through cervical vena-right atrium pathway under fluoroscopic monitoring to observe the influence of IVCF on BCIS. Then BCIS was es-tablished in the same sheep by compressing 10 mL of bone cement into a sheep medullary canal after mutilation of the left femur. Arterial blood pressure, heart rate, central venous pressure (CVP) and blood gas were monitored, while an ultrasonic device was utilized to monitor fat embolisms in the right atriums of the sheep. Oil red staining was performed to detect fat embolisms in pulmonary arteries after the sheep were executed. Results In BCIS group, dotted uneven resonances were found in the right atrium and right ventricle when the medullary canal pressure was increased to 120 mm Hg, indicating embolisms in the right chambers. The dotted resonances were increased to ponderous, snowflake-like ones as the medullary canal pressure climbed up. At the same time, blood pressure and Pa02 dropped significantly, the systolic blood pressure dropped to (80±11) mm Hg and PaO<.2> to the minimum 25 minutes after cone cement implantation. The heart rate and CVP increased continuously. The blood gas assay indicated respiratory and metabolic acidosis. The oil red staining showed bulk fat embolus in pulmonary arteries. But in IVCF group, the similar resonances were not observed throughout the surgery and the medullary canal pressure climbed to 400 mm Hg, reaching the maximum of our pressure gage range. The blood pressure, PaO2, heart rate and CVP did not change much compared to those before implantation. The blood gas and pulmonary oil red staining showed few changes either. Conclusion IVCF implantation can prevent the genesis of BCIS.