超声心动图联合呼气末CO2分压监测预防宫腔镜术中空气栓塞的临床研究  

Clinical study on echocardiography combined with end-tidal CO2 monitoring in preventing the venous air embolism during operative hysteroscopy

作　　者：许运巧[1] 张菊新[2] 

机构地区：[1]郑州大学第一附属医院妇产科,450052 [2]河南省人民医院妇产科

出　　处：《中华妇产科杂志》2013年第11期828-832,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的 探讨经胸廓超声心动图（TTE）联合呼气末CO2分压（PETCO2）监测预防宫腔镜术中空气栓塞的价值.方法 2010年8月至2012年8月,在河南省人民医院接受全身麻醉下宫腔镜手术的患者300例,在术中行TTE联合PETCO2监测,观察并详细记录右心房出现气栓的时间、空气栓塞分级（0～4级）、PETCO2、血氧饱和度、血压、液体负差值、术中出血量等.对空气栓塞分级≥3级,PETCO2下降≥5 mm Hg（1 mm Hg=0.133 kPa）的24例（干预组）患者给予立即停止手术、左侧卧位并抬高右肩、吸氧、地塞米松10 mg静脉滴注等;对空气栓塞分级≥3级,PETCO2下降＜5 mm Hg的5例（对照组）患者给予立即停止手术,严密观察病情变化.比较两组患者PETCO2继续下降例数、PETCO2恢复时间.结果 （1）空气栓塞发生情况：300例宫腔镜手术者中共有34例发生空气栓塞.发生空气栓塞的患者TTE均可在下腔静脉、右心房、右心室探及气栓信号,29例患者右心房有连续性的成群气栓通过,32例患者PETCO2下降＞2 mm Hg,14例患者血氧饱和度＜95％,4例患者血压下降≥20％.（2）PETCO2下降程度与空气栓塞分级变化：PETCO2下降程度与空气栓塞分级呈正相关（r=0.601,P＜0.01）,PET CO2下降≥5 mm Hg时,右心房均有连续性成群气栓通过,PETCO2下降≥10 mm Hg的8例中,7例患者空气栓塞分级为4级.空气栓塞分级为3级与4级者,PETCO2下降程度[分别为（7.5 ±2.4） mm Hg、（11.1±4.1）mm Hg]、液体负差值[分别为（688±150） ml、（925±268） ml]、术中出血量[分别为（71±36） ml、（127±56） ml]比较,差异均有统计学意义（P＜0.05）.（3） PETCO2继续下降例数及恢复时间：干预组与对照组患者PETCO2继续下降分别为2、4例,PETCO2恢复时间分别为（4.8±1.6）、（8.3±1.9） min,两组比较,差异均有统计学意义（P＜0.05）.结论 TTE联合PETCO2监测能有效预测宫腔镜术中空气栓塞的发生;右�Objective To explore the value of transthoracic echocardiography（TTE） combined with partial pressure of end-tidal CO2 （PETCO2） monitoring in preventing venous air embolism （VAE） during hysteroscopy operation.Methods From August 2010 to August 2012,300 cases undergoing hysteroscopic surgery under general anaesthesia were enrolled in this study.With the echocardiography combined with PETCO2 monitoring during hysteroscopic surgery,the time of VAE appearing in the right atrium,the extent of air embolism（grade 0-4）,the changes of PET CO2,peripheral oxygen saturation （SpO2）,blood pressure （Bp）,the amount of fluid intravasation and the blood loss were recorded in detail.Take the 24 cases that the grades of VAE in grade 3 or above and a decrease in PETCO2 ≥5 mm Hg （1 mm Hg =0.133 kPa） as intervention group.Stop operation immediately,the left side and raise your right shoulder,oxygen inhalation and dexamethasone 10 mg intravenous drip were given to the intervention group; the control group （5 cases in grade 3 or above and a decrease in PETCO2 ＜ 5 mm Hg） only stop operation immediately,observation patient＇s condition closely.Results （1） The occurrence of VAE：air embolism occurred in 34 patients among all 300 patients,all of 34 patients had evidence of gas embolism in the inferior vena cava,right atrium（RA） and right ventricle chamber,and 29 patients had evidence of continuous groups of gas emboli.There were 32 cases with the decrease in PETCO2 ＞ 2 mm Hg,14 cases with SpO2 less than 95％,and 4 cases with a drop in Bp ≥ 20％.（2） The change of the decrease of PET CO2 and the grades of VAE：the decrease of PETCO2 and the grades of VAE were positively correlated （r =0.601,P ＜ 0.01）,continuous groups of gas emboli signal in RA,when the drop of PETCO2 ≥5 mm Hg,8 of the 34 cases whose drop of PETCO2 ≥ 10 mm Hg,7 cases in grades 4.The decrease of PET CO2 [（7.5 ± 2.4） mm Hg versus （11.1 ±4.1）mm Hg],the amount of fluid intravasation[（688 ± 150） ml ver

关 键 词：栓塞 空气 超声心动描记术 二氧化碳捕记术 宫腔镜检查 

分 类 号：R445.1[医药卫生—影像医学与核医学]