经食管超声心动图观测宫腔镜术中心腔内气体栓子

Embolism Detected by Trans-esophageal Echocardiography During Hysteroscopy Procedures

目的：采用经食管超声心动图（TEE）观察宫腔镜术中心腔内气栓的发生率、发生的时间和程度及其对呼吸循环的影响。方法选择78例ASA Ⅰ～Ⅱ级在静脉全麻下行宫腔镜手术治疗患者，术中用TEE观察手术开始至手术结束心腔内气栓的发生率和程度；同时持续监测EGG、MAP、HR和SpO2，观察循环呼吸系统的变化。结果38例患者的右心房均观察到了气体栓子影像，发生率为48.7%，平均发生时间距膨宫介质灌注后12.33±7.78min，其中有5例是1级气泡，7例2级气泡，16例是3级气泡，10例是4级气泡。宫腔镜术中气栓级别与液体负差值、是否使用电刀有关（P〈0.05）。气栓发生时大部分患者无症状或症状不明显，心电监护多显示患者出现一过性心率增快和SpO2下降，面罩加压给氧后能快速改善。结论 TEE观察宫腔镜术中存在心腔内气体栓子并非罕见，应引起高度重视。

Objective To observe the incidence and level of gas embolism in patients underwent hysteroscopy procedures by trans-esophageal echocardiography（TEE）,as well as the changes in haemodynamic and respiratory variables. Methods Seventy-eight ASA-I or ASA-II patients underwent hysteroscopy procedures with general anesthesia were received intra-operative TEE monitoring.The severity and incidence of the gas embolism in the right atrium, EGG, SpO2, MAP, HR were observed and recorded. Results Gas embolism in the right atrium appeared in thirty-eight women（38 of 40） at （12.33±7.78） minutes after beginning of hysteroscopy procedures. Five patients were observed first grade of gas embolism, seven were observed second grade, sixteen were observed third grade, ten were observed fourth grade. The degree of gas embolism is relevant to intravasation of distension fluid and whether use monopolar or bipolar diathermia（P〈0.05）. When gas embolism occurred the majority of patients were asymptomatic or not obvious symptoms, ECG displayed more patients had a transient decrease in heart rate and SpO2,after pressurized oxygen mask patients can quickly be improved. Conclusions Gas embolism was not rare during therapeutic hysteroscopy,which was deserved to pay more attention.