妇科腔镜手术麻醉期间二氧化碳气腹气体栓塞8例临床分析

Clinical Analysis of 8 Cases with CO_2 Embolism of Aeroperitoneum in Laparoscopic Gynaecologic Surgery During Anesthesia

目的:分析二氧化碳(CO_2)气腹妇科腔镜手术发生气体栓塞的临床特点、可能原因和救治。方法:回顾性总结8例CO_2气腹下妇科腔镜手术麻醉期间气体栓塞,并与胆囊腚镜手术比较,分析其可能原因、临床特点、诊治经过和预后。结果:本组8例气栓病例发生率为0.148%。6例CO_2气栓的发生与气腹开始阶段的高流量和麻醉管理有关;除一例心脏骤停后植物生存状态外,其余病例特征为:(1)主要表现为肺栓塞,且术毕才出现低氧血症或当自主呼吸恢复时SpO_2多进行性下降,典型的呼吸困难和发绀;而术中未出现明显异常,尤其是监测P_(ET)CO_2变化不明显;(2)肺部听诊早期一侧肺局限性明显湿性啰音,后期非对称性啰音;(3)X线明显片状阴影:右下肺叶和中下肺叶大部片状影(5例)、左下肺叶(3例);(4)右下肺叶和中下肺叶大部片状影(5例):均CVP>12cmH_2O;心电图出现有意义的心电图改变:SIOⅢTⅢ,电轴右偏;(5)诊断性治疗明显有效。结论:CO_2气栓的发生可能与气腹建立、麻醉及妇科手术体位和手术部位有关;早期及时渗断和治疗能有效改善预后。

Objective：To analyse the relative factors that tend to bring about embolism when carrying laparoscopic gynaecologic surgery and as well as the clinical feature of gas embolism.Methods：The clinical datas of 8 patients with CO2 embolism were analysed retrospectively, i ncluding the causes, clinical features,process of diagnosis and treatment and prognosis.Results：The total incidence rate of gas embolism of this 8 cases was 0.148%.There were 5 cases with aeroembolism having something to do with anesthetic management and high flow capacity in the early stage of aeroperitoneum.The features were demonstrated as follow：（1）Pulmonary embolism that happened when the hyoxemia occured after the surgery or the autonomous respiration was recovered was the main manifestation, such as progressive decline of SpO2,typical dyspnea and cyanosis.However, there was nothing obviously abnormal during the anesthesia,especially the PETCO2.（2）A local moist rale could be heard on one side of the lung in early stage but in latter period the moist was asymmetrical.（3）X-ray flate presented a obvious flake-like shadow, which located in right lower lobe and mid lower lobe in 5 cases and in left lower lobe in 3 cases.（4）5 cases with flake-like shadow located in right lower lobe and mid lower lobe：CVP〉12cmH2O,significant changes in ECG：S Ⅰ QⅢTⅢ,right axis deviation.（5）Diagnostic treatment had remarkable effect.Conclusion：It is probably that the surgical position, operative site, establishment of aeroperitonenm and anaesthesia attribute to CO2 embolism, the prognosis of which can be improved by early diagnosis and early treatment.