山东医药
山東醫藥
산동의약
SHANDONG MEDICAL JOURNAL
2014年
30期
7-10
,共4页
刘胜群%李超伟%吕素平%刘月强%李站稳%赵素贞
劉勝群%李超偉%呂素平%劉月彊%李站穩%趙素貞
류성군%리초위%려소평%류월강%리참은%조소정
无创血流动力学监测%彩色多普勒超声监测%气体栓子%宫腔镜手术%气体栓塞%全身麻醉
無創血流動力學鑑測%綵色多普勒超聲鑑測%氣體栓子%宮腔鏡手術%氣體栓塞%全身痳醉
무창혈류동역학감측%채색다보륵초성감측%기체전자%궁강경수술%기체전새%전신마취
noninvasive hemodynamic monitoring%monitored using color Doppler ultrasonic imaging%gas embolus%hysteroscopic surgery%gas embolism%general anesthesia
目的:探讨宫腔镜手术中血流动力学变化对循环气体栓子(气栓)的预测价值。方法择期全身麻醉下行宫腔镜手术的患者120例,其中宫腔粘连41例、子宫内膜息肉35例、子宫黏膜下肌瘤28例、子宫纵膈9例、胚物残留7例。术中用彩色多普勒超声持续监测患者髂总静脉、上、下腔静脉及心脏中气栓的发生情况。无创血流动力学监测仪连续监测血流动力学指标;多功能监护仪监测ECG、SpO2、PET CO2。记录手术时间、出血量、气栓出现时间、气栓高峰时间及气栓高峰时间HR上升(较基础值升高30%或>120次/min)、PET CO2下降(较基础值降低10%或降低≥3 mmHg)情况。记录气栓出现时( T1)、气栓高峰( T2)、HR上升时( T3)、PET CO2下降时( T4)、气栓消失时(T5)的HR、MAP、SpO2、PETCO2、SV/SVI、CO/CI、SVR/SVRI、TFC、VI、ACI、PEP、LVET、STR、LCW/LCWI。观察手术并发症发生情况。结果超声监测显示120例术中有76例(63.3%)无气栓出现(A组),44例(36.7%)出现气栓,其中少量气栓(B组)27例(22.5%),中量气栓(C组)10例(8.3%),大量气栓(D组)7例(5.8%)。 D组手术时间、出血量高于其他三组(P均<0.05)。各组气栓出现时间、HR上升情况、PET CO2下降情况、MBP、SpO2、PET CO2、SV/SVI、CO/CI、SVR/SVRI、TFC、VI、ACI、PEP、LVET、STR、LCW/LCWI差异无统计学意义。对出现气栓患者予暂停手术、头低左侧卧及对症处理。120例患者未出现气体栓塞导致的死亡或伤残。结论超声监测可及时发现宫腔镜手术中循环气栓,无创血流动力学监测对气栓发生的诊断无明显特异性。
目的:探討宮腔鏡手術中血流動力學變化對循環氣體栓子(氣栓)的預測價值。方法擇期全身痳醉下行宮腔鏡手術的患者120例,其中宮腔粘連41例、子宮內膜息肉35例、子宮黏膜下肌瘤28例、子宮縱膈9例、胚物殘留7例。術中用綵色多普勒超聲持續鑑測患者髂總靜脈、上、下腔靜脈及心髒中氣栓的髮生情況。無創血流動力學鑑測儀連續鑑測血流動力學指標;多功能鑑護儀鑑測ECG、SpO2、PET CO2。記錄手術時間、齣血量、氣栓齣現時間、氣栓高峰時間及氣栓高峰時間HR上升(較基礎值升高30%或>120次/min)、PET CO2下降(較基礎值降低10%或降低≥3 mmHg)情況。記錄氣栓齣現時( T1)、氣栓高峰( T2)、HR上升時( T3)、PET CO2下降時( T4)、氣栓消失時(T5)的HR、MAP、SpO2、PETCO2、SV/SVI、CO/CI、SVR/SVRI、TFC、VI、ACI、PEP、LVET、STR、LCW/LCWI。觀察手術併髮癥髮生情況。結果超聲鑑測顯示120例術中有76例(63.3%)無氣栓齣現(A組),44例(36.7%)齣現氣栓,其中少量氣栓(B組)27例(22.5%),中量氣栓(C組)10例(8.3%),大量氣栓(D組)7例(5.8%)。 D組手術時間、齣血量高于其他三組(P均<0.05)。各組氣栓齣現時間、HR上升情況、PET CO2下降情況、MBP、SpO2、PET CO2、SV/SVI、CO/CI、SVR/SVRI、TFC、VI、ACI、PEP、LVET、STR、LCW/LCWI差異無統計學意義。對齣現氣栓患者予暫停手術、頭低左側臥及對癥處理。120例患者未齣現氣體栓塞導緻的死亡或傷殘。結論超聲鑑測可及時髮現宮腔鏡手術中循環氣栓,無創血流動力學鑑測對氣栓髮生的診斷無明顯特異性。
목적:탐토궁강경수술중혈류동역학변화대순배기체전자(기전)적예측개치。방법택기전신마취하행궁강경수술적환자120례,기중궁강점련41례、자궁내막식육35례、자궁점막하기류28례、자궁종격9례、배물잔류7례。술중용채색다보륵초성지속감측환자가총정맥、상、하강정맥급심장중기전적발생정황。무창혈류동역학감측의련속감측혈류동역학지표;다공능감호의감측ECG、SpO2、PET CO2。기록수술시간、출혈량、기전출현시간、기전고봉시간급기전고봉시간HR상승(교기출치승고30%혹>120차/min)、PET CO2하강(교기출치강저10%혹강저≥3 mmHg)정황。기록기전출현시( T1)、기전고봉( T2)、HR상승시( T3)、PET CO2하강시( T4)、기전소실시(T5)적HR、MAP、SpO2、PETCO2、SV/SVI、CO/CI、SVR/SVRI、TFC、VI、ACI、PEP、LVET、STR、LCW/LCWI。관찰수술병발증발생정황。결과초성감측현시120례술중유76례(63.3%)무기전출현(A조),44례(36.7%)출현기전,기중소량기전(B조)27례(22.5%),중량기전(C조)10례(8.3%),대량기전(D조)7례(5.8%)。 D조수술시간、출혈량고우기타삼조(P균<0.05)。각조기전출현시간、HR상승정황、PET CO2하강정황、MBP、SpO2、PET CO2、SV/SVI、CO/CI、SVR/SVRI、TFC、VI、ACI、PEP、LVET、STR、LCW/LCWI차이무통계학의의。대출현기전환자여잠정수술、두저좌측와급대증처리。120례환자미출현기체전새도치적사망혹상잔。결론초성감측가급시발현궁강경수술중순배기전,무창혈류동역학감측대기전발생적진단무명현특이성。
Objective To explore the value of noninvasive hemodynamic monitoring in predicting the gas embolus dur -ing hysteroscopic surgery .Methods A total of 120 patients, undergoing hysteroscopic surgery under general anesthesia were involved in this study (41 intrauterine adhesion , 35 endometrial polyp , 28 submucous uterine myoma , 9 uterus medi-astinum , 7 trophoblastic residual ) .Gas embolus in the common iliac vein , superior vena cava , inferior vena cava and heart cardiac were continuously monitored by using color Doppler ultrasonic imaging .The haemodynamic indexes were monitored by noninvasive hemodynamic monitoring.ECG, SpO2, PET CO2 were monitored as well.The operation time, blood loss, the appearance time of gas embolus , the appearance time of highest gas embolus and then the change of HR ( when HR >120 bpm or increased 30%compared with baseline ), PETCO2(when it was reduced more than10%compared with baseline or 3 mmHg) were recorded.The HR, MBP, SpO2 , PET CO2 , SV/SVI, CO/CI, SVR/SVRI, TFC, VI, ACI, PEP, LVET, STR, LCW/LCWI were recorded when appearance of the gas embolus (T1), the highest gas embolus appeared (T2), and the HR rise(T3), and when the PETCO2 decline (T4),the gas embolus disappeared(T5).Results Gas embo-lus donn't appeared(group A) in 76 patients of all the 120(63.3%).Gas embolus appeared in 44 patients(36.7%).A small number of gas embolus occurred in 27 cases(group B, 22.5%).A moderate number of gas embolus occurred in 10 cases(group C, 8.3%).A large number of gas embolus occurred in 7 cases(group D, 5.8%).The blood loss and opera-tion time of group D were significantly higher than the other groups (all P<0.05).There was no statistical differences in four groups at the appearance time of gas embolus , HR, PET CO2 , MBP, SpO2 , PET CO2 , SV/SVI, CO/CI, SVR/SVRI, TFC, VI, ACI, PEP, LVET, STR, LCW/LCWI.When the patients developed gas embolus , the operation were suspend , simultaneously, the left-Rlateral and head-Rdown position should be taken to avoid serious complications ( dead or disabli-ty) because of gas embolism .Conclusion There were no value of noninvasive hemodynamic monitoring in predicting the gas embolus during hysteroscopic surgery .But the ultrasonography can monitoring the gas embolus during hysteroscopic sur -gery immediately.