Liu Sheng-Qun, Zhao Su-Zhen, Li Zhan-Wen, Lv Su-Ping, Liu Yue-Qiang, Li Yi
Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China.
Experimental Medicine , Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China.
J Ultrasound Med. 2017 Apr;36(4):749-756. doi: 10.7863/ultra.16.03051. Epub 2017 Feb 2.
Previous studies have demonstrated a high frequency of gas emboli during hysteroscopy, but guidelines for the prevention, early detection, and intervention of gas embolism during hysteroscopic procedures are still lacking. This study aimed to gain a clearer understanding of risk factors and specific signs and symptoms associated with gas emboli.
This prospective study enrolled 120 women scheduled for hysteroscopy using 5% glucose as distension medium. The gas bubbles were monitored sequentially in internal iliac vein, common iliac vein, inferior vena cava, superior vena cava, heart, and pulmonary artery under the gray-scale imaging of Doppler ultrasound. The frequency, extent, and the hemodynamic and respiratory effects of gas emboli were evaluated. The interventions and outcomes were recorded. The risk factors associated with gas emboli, and their relationship with the frequency and extent of gas emboli, were assessed.
In our study, evidence of gas emboli under Doppler ultrasound monitoring was observed in 44 (36.7%) patients. The operation was continued and finished as soon as possible for patients presenting with stable vital signs or transient hemodynamic and respiratory changes, which resolved spontaneously without intervention. The operation was paused for patients presenting with significant hemodynamic changes or loss of consciousness, and the operation was resumed shortly after resumption of stable vital signs following symptomatic treatment. All patients in our study finished the operation and recovered without developing serious complications. Data analysis showed prolonged procedure duration and increased bleeding volume were both positively correlated with the frequency and extent of gas emboli.
Our study demonstrated a high frequency of gas emboli during hysteroscopy. Doppler ultrasonic monitoring combined with a clearer understanding of specific signs, symptoms, and risk factors will facilitate early detection and intervention of gas emboli during hysteroscopy.
既往研究已证实在宫腔镜检查期间气体栓塞的发生率很高，但仍缺乏宫腔镜手术期间气体栓塞的预防、早期检测及干预指南。本研究旨在更清楚地了解与气体栓塞相关的危险因素以及特定的体征和症状。
本前瞻性研究纳入了120例计划使用5%葡萄糖作为膨宫介质进行宫腔镜检查的女性。在多普勒超声的灰阶成像下，依次监测髂内静脉、髂总静脉、下腔静脉、上腔静脉、心脏和肺动脉中的气泡。评估气体栓塞的发生率、程度以及对血流动力学和呼吸的影响。记录干预措施及结果。评估与气体栓塞相关的危险因素及其与气体栓塞发生率和程度的关系。
在我们的研究中，44例（36.7%）患者在多普勒超声监测下有气体栓塞的证据。对于生命体征稳定或出现短暂血流动力学和呼吸变化且无需干预即可自行缓解的患者，手术继续并尽快完成。对于出现明显血流动力学变化或意识丧失的患者，手术暂停，在对症治疗后生命体征恢复稳定后不久恢复手术。我们研究中的所有患者均完成手术且康复，未发生严重并发症。数据分析显示，手术时间延长和出血量增加均与气体栓塞的发生率和程度呈正相关。
我们的研究表明宫腔镜检查期间气体栓塞的发生率很高。多普勒超声监测以及对特定体征、症状和危险因素的更清楚了解将有助于在宫腔镜检查期间早期检测和干预气体栓塞。
