不同部位下腔静脉超声联合肺部超声指导宫腔镜四级手术患者容量治疗效果的比较  

Comparison of volume therapy guided by inferior vena cava ultrasound and lung ultrasound at different sites in patients undergoing grade four hysteroscopic surgery

作　　者：李征[1] 郭高锋[1] 蒋璐璐 阮孝国[1] 张加强[1] Li Zheng;Guo Gaofeng;Jiang Lulu;Ruan Xiaoguo;Zhang Jiaqiang(Department of Anesthesiology and Perioperative Medicine,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院麻醉与围术期医学科,郑州450003

出　　处：《中华麻醉学杂志》2022年第12期1465-1468,共4页Chinese Journal of Anesthesiology

基　　金：河南省中青年卫生健康科技创新领军人才培养项目(YXK2020001)。

摘　　要：目的:比较不同部位下腔静脉超声联合肺部超声指导宫腔镜四级手术患者容量治疗的效果。方法:择期全麻下行宫腔镜四级手术患者90例,年龄18~64岁,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为3组(n=30):常规组(C组)、剑突下超声组(S组)及右侧腹腋中线超声组(R组)。当下腔静脉扩张指数<15%或肺部超声B线积分>8.5分或动脉血气Na^(+)浓度<125 mmol/L时建议外科医生加快手术进程,降低膨宫压力并静脉注射呋塞米10~20 mg,同时调整输液速度。于入室(T_(0))、麻醉诱导后20 min(T_(1))、诱导后40 min(T_(2))和术毕(T_(3))时记录肺部超声B线积分、乳酸和Na^(+)浓度、PaO_(2)/FiO_(2),记录术后相关并发症发生情况、膨宫液用量、输液量和喉罩拔除时间。结果:与C组比较,S组、R组肺部超声B线积分降低,Na^(+)浓度和PaO_(2)/FiO_(2)升高,喉罩拔除时间缩短,膨宫液用量减少,R组并发症总发生率降低(P<0.05)。与S组比较,R组肺部超声B线积分降低,PaO_(2)/FiO_(2)升高,膨宫液用量减少(P<0.05)。结论:与经剑突下比较,经右侧腹腋中线下腔静脉超声联合肺部超声指导宫腔镜四级手术患者容量治疗更具优势。Objective To compare the efficacy of volume therapy guided by inferior vena cava ultrasound and lung ultrasound at different sites in patients undergoing grade four hysteroscopic surgery.Methods A total of 90 patients,aged 18-64 yr,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,undergoing elective grade four hysteroscopic surgery under general anesthesia,were divided into 3 groups(n=30 each)using a random number table method:conventional group(C group),ultrasound at the subcostal area group(S group)and ultrasound at right mid-axillary line group(R group).When the inferior vena cava distensibility index<15%or pulmonary ultrasound B-line score>8.5 or arterial blood gas Na^(+)concentrations<125 mmol/L,surgeons were advised to speed up the process of surgery and decrease the pressure of uterine distention,furosemide 10-20 mg was intravenously injected,and the speed of infusion was adjusted at the same time.On admission to the operating room(T_(0)),at 20 min after induction(T_(1)),40 min after induction(T_(2)),and at the end of operation(T_(3)),the B-line score of lung ultrasound,concentrations of Lac and Na^(+)and PaO_(2)/FiO_(2) were recorded,and the postoperative complications,amount of uterine distention fluid,volume of fluid infused and time of laryngeal mask airway removal were recorded.Results Compared with group C,the pulmonary ultrasound B-line score was significantly decreased,the concentrations of Na^(+)and PaO_(2)/FiO_(2) were increased,the time of laryngeal mask airway removal was shortened,and the amount of uterine distention fluid was decreased in S and R groups,and the total incidence of complications was significantly decreased in group R(P<0.05).Compared with group S,the lung ultrasound B-line score was significantly decreased,PaO_(2)/FiO_(2) was increased,and the amount of uterine distention fluid was decreased in group R(P<0.05).Conclusions Compared with subxiphoid process,the volume therapy guided by inferior vena cava ultrasound on the right mid-axillary line and

关 键 词：宫腔镜检查 超声检查 下腔静脉 肺 

分 类 号：R614[医药卫生—麻醉学]