动静脉畸形无水乙醇栓塞治疗时异常血流动力学波动

Abnormal effect of absolute ethanol sclerotherapy for arteriovenous malformations on hemodynamics

目的:总结无水乙醇栓塞治疗动静脉畸形过程中血流动力学的异常波动情况,探讨其规律并试图分析其原因。方法:选择我院日间病房择期于全身麻醉下行无水乙醇栓塞治疗时出现异常波动的动静脉畸形患者12例,记录动静脉畸形注射无水乙醇前后有创血压、心率、脉搏氧饱和度及呼气末二氧化碳分压的变化情况。结果:注射无水乙醇前血压平均为(98.6±6.5)mmHg/(53.1±3.3)mmHg,心率平均为(82.8±11.5)bpm;注射无水乙醇后,心率先明显增快、再下降、最后恢复到注射前水平,最高值平均高达(98.8±13.5)bpm;血压先下降、再上升、再逐渐恢复到注射前水平,最低值平均为(73.7±6.3)mmHg/(39.3±4.8)mmHg;该段时间脉搏氧饱和度及呼气末二氧化碳分压无明显变化。结论:动静脉畸形注射无水乙醇后数分钟内血压、心率可能出现明显的异常S形波动,确切原因有待进一步研究,但术中需加强监测,必要时予以纠正,以减少并发症的发生。

PURPOSE：To observe and analyze the abnormal effect of ethanol sclerotherapy for arteriovenous malformations on hemodynamics. METHODS：Twelve cases of arteriovenous malformations who received absolute ethanol selerotherapy were chosen. The heart rate, blood pressure, SPO2 and ETCO2 at different times were recorded and analyzed. RESULTS： Obvious change of HR and BP were observed before and after injection of absolute ethanol into arteriovenous malformation. HR changed from preoperational （82.8±11.5）bpm to the highest （98.8±13.5）bpm, While BP changed from preoperational （98.6±6.5）mmHg/（53.1±3.3）mmHg to the lowest （73.7±6.3）mmHg/（39.3±4.8）mmHg. No change of SPO2 and PETCO2 was observed. CONCLUSIONS： Absolute ethanol sclerotherapy for arteriovenous malformation can result in obvious S-shaped change of HR and BP. The actual cause is unknown, but we should pay more attention to the abnormal changes and manage accordingly.