宫腔镜术中严重气体栓塞相关因素研究

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。

Clinical research on related factors of serious gas embolism in hysteroscopy surgery.

Abstract： Objective To explore factors related to circulating gas embolism occurrence and causes of symptoms during hysteroscopic surgery. Methods In the 34 cases undergoing hysteroscopic surgery,conditions of circulating gas embolism were monitored and leveled by the Doppler. Results Twenty patients of all 34 patients had gas embolism, and 6 patients had symptoms; 2 out of 5 were symptomatic in grade Ⅱ gas embolism group, while 4 out of 6 in grade Ⅲ. Symptoms were positively correlated with levels of gas embolism. In 26 cases whose operation time was over 30 minutes, gas embolism occurred in 18 patients, and 6 patients had symptoms,which showed increasing probability of gas embolism levels and clinical symptoms. No gas embolism occurred when the perfusion volume was<2000 mL,while 5 out of 10 cases with perfusion volume 2000 to 3000ml and 15 out of 20 with over 3000ml developed gas embolism, 1 and 5 cases had symptoms respectively. The incidence of gas embolism and occurrence of clinical symptoms increased significantly with the perfusion volume. Conclusions A close relationship between the occurrence of clinical symptoms and gas embolism is observed. Low-degree gas embolism has no serious damage. The degree of gas embolism can be used as an option to predict the occurrence of serious complications.The level of gas embolism is related to the clinical symproms.