经食管超声心动图在宫腔镜术中患者心腔内气体栓塞状况的监测

Application of TEE to monitor intracardiac gas embolism during hysteroscopy

目的：采用经食管超声心动图（TEE）观察宫腔镜手术中，心腔内气体栓子的发生率、发生的时间和程度及其对循环呼吸的影响。方法：选择静脉全麻下行宫腔镜手术治疗患者40例（ASAⅠ-Ⅱ级），术中运用TEE观察手术开始至手术结束心腔内气栓的发生率；同时监测肺动脉收缩压变化，并观察是否存在室壁运动异常（SWMAs）。结果：在选择的40例患者中，有38例患者在静脉全麻下行宫腔镜手术，术中TEE均显示心腔内见气体栓子，其中有5例（13．2％）是1级气泡，7例（18．4％）2级气泡，16例（42．1％）是3级气泡。10例（26．3％）是4级气泡。术中24例（63．2％）患者出现室壁运动异常（SWMAs），此时肺动脉收缩压由术前的（18．3±2．7）mmHg增加到气栓时的（24．3±3．2）mmHg（P〈0．05）；SWMAs分级与空气栓塞级别呈正相关（r=0．655。P〈0．01），空气栓塞3～4级者发生SWMAs改变者明显高于空气栓塞1～2级者（P〈0．05）；术中4级气栓患者中有5例（13．1％）出现心率增快，最快达120次／min，ECG显示为窦性心动过速，ST段压低，15例（39．5％）患者伴有一过性SpO2下降，在93％-94％之间，持续时间数2～5min。结论：在宫腔镜术中应用TEE进行动态监测，可及时发现患者心腔内气体栓塞变化状况，为麻醉医师采用干预措施．避免患者发生恶性心律失常或导致心肌缺血事件发生，保障患者手术安全创造了条件，临床应积极地选用。

Objective To observe the incidence and the rate of embolism in patients undergoing hysteroscopy procedures by using the transesophageal echocardiography （TEE）, as well as the changes of respiratoric and haemodynamic variables. Methods Fourty ASA Ⅰ- Ⅱ patients undergoing hysteroscopy procedures under general anesthesia received intraoperative TEE monitoring. The systolic pulmonary artery pressure, the incidence of the venous gas embolism （VGE） and the eegmental wall motion abnormality （SWMAs） were observed. Results In the 40 patients, 38 patients received intravenous anesthesia hysteroscopic surgery, with the intraoperative TEE to monitor the intracardiac VGE. The degree of gas embolism was related with the perfusion and the usage of monopolar or bipolar diathermia （P 〈 0.05）. The systolic pulmonary artery pressure promoted and SWMAs were also observed. Conclusions The continue TEE monitor during hysteroscopy could detect the intracardiac gas embolism in time, contributing to early diagnosis and avoiding the occurrence of malignant arrhytbmias or myocardial ischemic events.