Orthopedics and Traumatology, Hip Preservation Unit, Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia.
Research Institute, Centro Médico Imbanaco, Cali, Colombia.
Arthroscopy. 2020 Jan;36(1):139-147. doi: 10.1016/j.arthro.2019.07.031.
To evaluate the relationship between the intraoperative monitoring factors with intra-abdominal fluid extravasation (IAFE) in patients who underwent hip arthroscopy. The secondary purpose was to describe the main intraoperative variables between cases with and without IAFE.
We carried out a prospective observational study of 106 hip arthroscopies between June 2017 and June 2018. Within procedures, 54 cases with deep gluteal syndrome (DGS) were included. Ultrasonography was performed by a trained anesthesiologist before and after the surgery to identify the presence of fluid. The hepatorenal (Morison's pouch), splenorenal, retroaortic, suprapubic (longitudinal and transverse), and pleural spaces were examined. During the surgery, the blood pressure, heart rate, temperature, peak inspiratory pressure (PIP), pulmonary compliance, oxygen saturation, and end-tidal carbon dioxide were registered.
The incidence of IAFE was 31.1% (33/106; 95% confidence interval 23.0%-40.5%). IAFE in cases with isolated FAI was 15.9% (7/44) in comparison with 52.9% (9/17) of the cases with isolated DGS. Maximum values of PIP greater than 20 mm Hg were associated with fluid extravasation (odds ratio 3.22; 95% confidence interval 1.07-9.68). No statistically significant relationship was found in blood pressure, heart rate, temperature, oxygen saturation, end-tidal carbon dioxide, and pulmonary compliance between cases with and without IAFE.
Asymptomatic IAFE, as measured by ultrasound, is a frequent event in patients who underwent hip arthroscopy, mainly in cases with DGS. PIP was found to be a useful intraoperative monitoring parameter for the early identification of IAFE in hip arthroscopy.
Level II, observational prospective cohort study.
评估髋关节镜检查患者术中监测因素与腹腔内液体外渗（IAFE）之间的关系。次要目的是描述有和无 IAFE 病例之间的主要术中变量。
我们对 2017 年 6 月至 2018 年 6 月期间进行的 106 例髋关节镜检查进行了前瞻性观察研究。在手术过程中，纳入了 54 例深部臀肌综合征（DGS）患者。由一名受过培训的麻醉师在手术前后进行超声检查，以确定是否存在液体。检查肝-肾（莫里森氏囊）、脾-肾、主动脉后、耻骨上（纵向和横向）和胸膜间隙。在手术过程中，记录血压、心率、体温、吸气峰压（PIP）、肺顺应性、血氧饱和度和呼气末二氧化碳。
IAFE 的发生率为 31.1%（33/106；95%置信区间 23.0%-40.5%）。在单纯性 FAI 病例中，IAFE 的发生率为 15.9%（7/44），而在单纯性 DGS 病例中，IAFE 的发生率为 52.9%（9/17）。PIP 大于 20mmHg 的最大值与液体外渗相关（比值比 3.22；95%置信区间 1.07-9.68）。在有和无 IAFE 的病例之间，血压、心率、体温、血氧饱和度、呼气末二氧化碳和肺顺应性均无统计学显著差异。
在髋关节镜检查患者中，通过超声测量，无症状的 IAFE 是一种常见事件，主要发生在 DGS 病例中。发现 PIP 是髋关节镜检查中早期识别 IAFE 的一种有用的术中监测参数。
II 级，观察性前瞻性队列研究。
