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目的探讨宫腔镜手术中发生循环气体栓塞(气栓)的相关因素及症状出现的原因。方法观察郑州大学人民医院2010-08-04至2010-12-31收治的34例宫腔镜手术患者,采用超声多普勒监测循环中气栓的情况,并进行分级;分析不同级别气栓、手术时间、灌注量、单双极电切与临床症状或体征出现的关系。结果 34例患者中发现循环气栓20例,出现症状6例,无气栓者无症状出现;Ⅱ级气栓5例,出现症状2例,Ⅲ级气栓6例,出现症状4例,症状出现与气栓级别呈正相关;手术时间>30 min者26例,气栓18例,出现症状6例,气栓级别及临床症状率均显著增加;灌注量>3000 mL 20例,气栓15例,出现症状4例,随灌注量增多,气栓及临床症状出现例数明显增多,差异有统计学意义;单极电切20例,发现气栓12例,出现症状5例;双极14例,发现气栓8例,出现症状1例,发现气栓及出现症状差异无统计学意义。结论宫腔镜手术临床症状与气栓关系密切,低级别气栓对机体无严重损伤。气栓分级可以预测严重并发症的出现,气栓的等级与临床症状的出现有相关性。
Objective To investigate the related factors of recurrent gas embolism (HG) in hysteroscopic surgery and the causes of the symptoms. Methods 34 cases of hysteroscopic surgery admitted from 2010-08-04 to 2010-12-31 in People’s Hospital of Zhengzhou University were enrolled. Ultrasound Doppler was used to monitor the situation of air embolism in the circulation and to classify them. Operative time, perfusion, single bipolar resection and clinical symptoms or signs of the relationship. Results In 34 patients, 20 cases of recurrent air embolism were found, 6 cases showed symptoms, 7 cases showed no symptoms with no embolism, 5 cases had stage Ⅱ air embolism, 2 cases showed symptoms, 6 cases had stage Ⅲ air embolism, and 4 cases showed symptoms. There was a positive correlation with the level of thrombus; surgery time> 30 min in 26 cases, 18 cases of air embolism, symptoms in 6 cases, the level of air embolism and clinical symptoms were significantly increased; perfusion> 3000 mL in 20 cases, air plume in 15 cases , There were 4 cases of symptoms, with the increase of perfusion, the number of cases of gas bolt and clinical symptoms increased significantly, the difference was statistically significant; unipolar shunt in 20 cases, found in 12 cases of air embolism, symptoms in 5 cases; bipolar 14 cases , Found in 8 cases of gas embolism, 1 case of symptoms, found no difference in gas bolt and symptoms. Conclusion The clinical symptoms of hysteroscopic surgery are closely related to air embolism. Low-level air plugs have no serious damage to the body. The classification of the thrombus can predict the occurrence of serious complications, and the grade of the airbrush is correlated with the appearance of clinical symptoms.