经食管超声心动图鉴别心腔内空气和脂肪栓子的可行性  

Feasibility of using transesophageal echocardiography to differentiate between air and fat emboli in cardiac chambers

作　　者：王爱忠[1] 周明[1] 张卫兴[2] 江伟[1] 

机构地区：[1]上海交通大学医学院附属上海第六人民医院麻醉科,200233 [2]上海交通大学医学院附属上海第六人民医院超声科,200233

出　　处：《中华麻醉学杂志》2008年第8期715-718,共4页Chinese Journal of Anesthesiology

摘　　要：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40～48kg，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0．1ml／kg，间隔30min，然后依次注射空气0．2、0．5和1ml／kg，随后每次增加1ml／kg，注射速率为2ml／s，间隔60min，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0．025ml／kg，间隔30min，随后依次注射脂肪0．05和0．1ml／kg，随后每次增加0．1ml／kg，注射速率为2ml／s，间隔60min，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≥0．5nd／kg后，回声团直径〉5mm，回声模式3级。注射大剂量空气（≥0．5ml／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〈0．01）。结论TEE可鉴别心腔内空气栓子和脂肪栓子。Objective To evaluate the feasibility of using transesophageal eehoeardiography （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 l0 mg/kg. Anesthesia was maintained with phenobarbital 10 mg·kg^-1· h^-1 . Tracheal intubation 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, PETCO2, lung compliance （CL）, airway pressure （Paw） and the difference between 02 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＂12 . 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 rain 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 min 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 emboli, 1 = fine emboli, 2 = diameter of emboli 〈 5 ram, 3 = diameter of emboli 〉 5 nun）. The paradoxical embolism anti peteehiae 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 i

关 键 词：超声心动描记术 经食管 栓塞 空气 栓塞 脂肪 

分 类 号：R614[医药卫生—麻醉学]