摘要
目的采用经食道超声心动图(TEE)观察非骨水泥型全髋置换术心腔内栓子的发生率、发生的时段和程度及其对呼吸循环的影响。方法选择14例ASAⅡ-Ⅲ级在全麻下行非骨水泥型全髋置换术的患者,术中用TEE观察手术开始、磨锉髋臼、植入髋臼假体、股骨锉髓、股骨假体植入和关节复位各时间段心腔内栓子的发生率和程度;同时行有创血压监测和动脉血气分析,观察循环呼吸系统的变化。结果所有患者的右心房均观察到了"阵雪样"的栓子影像,其中植入髋臼假体、扩髓、股骨假体植入及关节复位时最显著;心率(HR)、脉氧饱和度(SpO2)、呼末二氧化碳(ETCO2)、氧分压(PO2)全程无明显变化,收缩压(SBP)和舒张压(DBP)在关节复位后明显下降(P<0·01)。结论 TEE观察非骨水泥型全髋关节置换术中普遍存在着心腔内微栓子,应引起高度重视。
Objective To observe the incidence and level of embolism in patients undergoing uncemented total hip replacement by traMs-esophageal echocardiography （TEE） , as well as the changes in haemodynamic and respiratory variables. Methods Fourteen consecutive patients undergoing uncemented total hip replacement under general anesthesia received intra-operative TEE monitoring. The severity and incidence of the embolism in the right atrium at various operative stages were observed. Haemodynamic and blood-gas variables were measured repeatedly during the operative procedure. Grading of embolism was based on the density and size of particles detected by TEE and correlated with haemodynamic and blood-gas data. Results Echogenic material showers like ＂ snow flurries＂ were detected in all patients, and particularly remarkable during the acetabular and femoral component insertion, reaming of the femur and the hip joint reduction. Heart rate, oxygen saturation, end-tidal carbon dioxide and oxygen partial pressure varied little during the operation. However, systolic blood pressure and diastolic blood pressure markedly decreased after reduction of the hip joint （ P 〈 0. 01 ）. Conclusions Embolisms are common during uncemented total hip replacement, which deserves more attention.
出处
《中华关节外科杂志（电子版）》
CAS
2011年第2期11-14,共4页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
关节成形术
置换
髋
超声心动描记术
经食管
栓塞
Replacement, replacement, hip
Echocardiography, transesophageal
Embolism
