Brundin J, Thomasson K
Department of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital, Sweden.
Eur J Obstet Gynecol Reprod Biol. 1989 Dec;33(3):241-5. doi: 10.1016/0028-2243(89)90136-6.
A relatively high number of fatal complications during hysteroscopy, where carbon dioxide was used as the uterine distension medium, plus a recent report on heart embolism during dog experiments with venous carbon dioxide infusion, audible by simple stethoscopic surveillance during the infusion, prompted the present study. Seventy women with no history of cardiac valvular disease or failure were observed during carbon dioxide hysteroscopy for the occurrence of the characteristic metallic heart sound caused by the intracardiac presence of free carbon dioxide during the heart contractions. In seven cases (10%) the typical metallic heart sounds appeared during the hysteroscopy, leading to immediate interruption of the hysteroscopy and withdrawal of the hysteroscope. This caused the pathological heart sounds to disappear, after which the hysteroscopy could continue. Heart auscultation should always be performed during carbon dioxide hysteroscopy in order to avoid serious cardiovascular complications. This simple precaution turns carbon dioxide hysteroscopy into a versatile and safe method for intra-uterine diagnosis and therapy.
在宫腔镜检查中，当使用二氧化碳作为子宫扩张介质时，出现了相对较高数量的致命并发症，再加上最近一份关于在犬类实验中静脉输注二氧化碳期间发生心脏栓塞的报告，在输注过程中通过简单的听诊监测即可听到，这些促使了本研究的开展。在70名无心脏瓣膜病或心力衰竭病史的女性进行二氧化碳宫腔镜检查期间，观察心脏收缩时心腔内游离二氧化碳的存在所引起的特征性金属心音的发生情况。7例（10%）在宫腔镜检查期间出现典型的金属心音，导致宫腔镜检查立即中断并拔出宫腔镜。这使得病理性心音消失，之后宫腔镜检查可以继续进行。在二氧化碳宫腔镜检查期间应始终进行心脏听诊，以避免严重的心血管并发症。这一简单的预防措施使二氧化碳宫腔镜检查成为一种用于子宫内诊断和治疗的通用且安全的方法。
