高中心静脉压对椎体手术病人静脉气体栓塞发生影响

EFFECT OF HIGH CENTRAL VENOUS PRESSURE ON VENOUS AIR EMBOLISM IN PATIENTS UNDERGOING VERTEBRAL SURGERY

目的评估后路椎体间融合术中静脉气体栓塞(VAE)的分级及高中心静脉压(CVP)对VAE的影响。方法将166例拟在全麻下行后路椎体间融合术病人随机分为对照组(n=82)和高CVP组(HCVP组,n=84)。手术中对照组快速补充乳酸林格液使CVP达到0.49 kPa,HCVP组快速补充乳酸林格液使CVP达到目标值,采用经食管超声心动图(TEE)监测并评估两组VAE分级。结果164例病人完成研究。对照组VAE主要分布在Ⅱ级,HCVP组VAE主要分布在0级(未发生VAE),HCVP组VAE分级明显低于对照组,差异有统计学意义(U=4.57,P<0.01)。结论接受后路椎体间融合术的病人,手术中维持高CVP可有效预防VAE的发生,提高手术安全性。

Objective To investigate the grade of venous air embolism(VAE)during posterior interbody fusion and the effect of high central venous pressure(CVP)on VAE.Methods A total of 166 patients who planned to undergo posterior interbody fusion under general anesthesia were randomly divided into control group with 82 patients and high CVP group(HCVP group)with 84 patients.During surgery,the patients in the control group were given fast replenishment of Ringer’s lactate solution to reach a CVP of 0.49 kPa,and those in the HCVP group were given fast replenishment of Ringer’s lactate solution to reach the target value of CVP.Transesophageal echocardiography was used for monitoring and assessment of the grade of VAE.Results A total of 164 patients completed the study.Most patients in the control group had grade Ⅱ VAE,while most patients in the HCVP group had group 0 VAE(no VAE),and the HCVP group had a significantly lower grade of VAE than the control group(U=4.57,P<0.01).Conclusion For patients undergoing posterior interbody fusion,high CVP during surgery can effectively prevent VAE and improve surgical safety.