高中心静脉压对椎体手术病人静脉气体栓塞发生影响(1)
[摘要] 目的 评估后路椎体间融合术中静脉气体栓塞(VAE)的分级及高中心静脉压(CVP)对VAE的影响。
方法 将166例拟在全麻下行后路椎体间融合术病人随机分为对照组(n=82)和高CVP组(HCVP组，n=84)。手术中对照组快速补充乳酸林格液使CVP达到0.49 kPa，HCVP组快速补充乳酸林格液使CVP达到目标值，采用经食管超声心动图(TEE)监测并评估两组VAE分级。
结果 164例病人完成研究。对照组VAE主要分布在Ⅱ级，HCVP组VAE主要分布在0级(未发生VAE)，HCVP组VAE分级明显低于对照组，差异有统计学意义(U=4.57，P<0.01)。
结论 接受后路椎体间融合术的病人，手术中维持高CVP可有效预防VAE的发生，提高手术安全性。
[关键词] 栓塞，空气;中心静脉压;椎体成形术;超声心动描记术，经食管
[中图分类号] R614.2;R543
[文獻标志码] A
[文章编号] 2096-5532(2019)06-0670-05
doi：10.11712/jms201906010
[开放科学(资源服务)标识码(OSID)]
EFFECT OF HIGH CENTRAL VENOUS PRESSURE ON VENOUS AIR EMBOLISM IN PATIENTS UNDERGOING VERTEBRAL SURGERY
LIU Wenyi， WANG Junhuan， XU Xiaolin， XU Min， WANG Manrui， SHAO Cuihua
(Department of Anesthesiology， The Affiliated Hospital of Qingdao University， Qingdao 266003， China)
[ABSTRACT] Objective To investigate the grade of venous air embolism (VAE) during posterior interbody fusion and the effect of high central venous pressure (CVP) on VAE.
Methods A total of 166 patients who planned to undergo posterior interbody fusion under general anesthesia were randomly divided into control group with 82 patients and high CVP group (HCVP group) with 84 patients. During surgery， the patients in the control group were given fast replenishment of Ringer’s lactate solution to reach a CVP of 0.49 kPa， and those in the HCVP group were given fast replenishment of Ringer’s lactate solution to reach the target value of CVP. Transesophageal echocardiography was used for monitoring and assessment of the grade of VAE.
Results A total of 164 patients completed the study. Most patients in the control group had grade Ⅱ VAE， while most patients in the HCVP group had group 0 VAE (no VAE)， and the HCVP group had a significantly lower grade of VAE than the control group (U=4.57，P<0.01).
Conclusion For patients undergoing posterior interbody fusion， high CVP during surgery can effectively prevent VAE and improve surgical safety.
[KEY WORDS] embolism， air; central venous pressure; vertebroplasty; echocardiography， transesophageal
静脉气体栓塞(VAE)是气体通过手术部位进入到静脉系统及心脏的手术并发症，严重者可以发生循环骤停[1]。VAE在多种手术中时有发生[2-3]。VAE发生的直接原因是破损的静脉血管内部压力小于外界大气压[4]，故增加中心静脉压(CVP)进而提高静脉血管内压力就应该可以降低VAE发生的可能。本研究采用经食管超声心动图(TEE)检查评估行后路椎体间融合术病人术中VAE分级，以及提高CVP对VAE的影响。
1 资料和方法
1.1 对象及分组
以2014年11月—2017年11月到我院就医拟在全麻下行后路椎体间融合术的166例病人为研究对象，其中男80例、女86例，年龄30～50岁，ASAⅠ～Ⅱ级。术前均无严重心肺疾病，肝肾功能无明显异常，均除外先天性心脏病及胃食管疾病病人。所有手术均由同一外科医生完成，手术处理两个节段的病变腰椎。本研究获医院伦理委员会批准，病人或家属签署知情同意书。采用随机数生成器将166例病人分成两组，奇数分配到对照组(n=82)，偶数分配到高CVP组(HCVP组，n=84)。, 百拇医药(刘文义 王俊环 徐晓林 徐敏 王曼睿 邵翠华)
方法 将166例拟在全麻下行后路椎体间融合术病人随机分为对照组(n=82)和高CVP组(HCVP组，n=84)。手术中对照组快速补充乳酸林格液使CVP达到0.49 kPa，HCVP组快速补充乳酸林格液使CVP达到目标值，采用经食管超声心动图(TEE)监测并评估两组VAE分级。
结果 164例病人完成研究。对照组VAE主要分布在Ⅱ级，HCVP组VAE主要分布在0级(未发生VAE)，HCVP组VAE分级明显低于对照组，差异有统计学意义(U=4.57，P<0.01)。
结论 接受后路椎体间融合术的病人，手术中维持高CVP可有效预防VAE的发生，提高手术安全性。
[关键词] 栓塞，空气;中心静脉压;椎体成形术;超声心动描记术，经食管
[中图分类号] R614.2;R543
[文獻标志码] A
[文章编号] 2096-5532(2019)06-0670-05
doi：10.11712/jms201906010
[开放科学(资源服务)标识码(OSID)]
EFFECT OF HIGH CENTRAL VENOUS PRESSURE ON VENOUS AIR EMBOLISM IN PATIENTS UNDERGOING VERTEBRAL SURGERY
LIU Wenyi， WANG Junhuan， XU Xiaolin， XU Min， WANG Manrui， SHAO Cuihua
(Department of Anesthesiology， The Affiliated Hospital of Qingdao University， Qingdao 266003， China)
[ABSTRACT] Objective To investigate the grade of venous air embolism (VAE) during posterior interbody fusion and the effect of high central venous pressure (CVP) on VAE.
Methods A total of 166 patients who planned to undergo posterior interbody fusion under general anesthesia were randomly divided into control group with 82 patients and high CVP group (HCVP group) with 84 patients. During surgery， the patients in the control group were given fast replenishment of Ringer’s lactate solution to reach a CVP of 0.49 kPa， and those in the HCVP group were given fast replenishment of Ringer’s lactate solution to reach the target value of CVP. Transesophageal echocardiography was used for monitoring and assessment of the grade of VAE.
Results A total of 164 patients completed the study. Most patients in the control group had grade Ⅱ VAE， while most patients in the HCVP group had group 0 VAE (no VAE)， and the HCVP group had a significantly lower grade of VAE than the control group (U=4.57，P<0.01).
Conclusion For patients undergoing posterior interbody fusion， high CVP during surgery can effectively prevent VAE and improve surgical safety.
[KEY WORDS] embolism， air; central venous pressure; vertebroplasty; echocardiography， transesophageal
静脉气体栓塞(VAE)是气体通过手术部位进入到静脉系统及心脏的手术并发症，严重者可以发生循环骤停[1]。VAE在多种手术中时有发生[2-3]。VAE发生的直接原因是破损的静脉血管内部压力小于外界大气压[4]，故增加中心静脉压(CVP)进而提高静脉血管内压力就应该可以降低VAE发生的可能。本研究采用经食管超声心动图(TEE)检查评估行后路椎体间融合术病人术中VAE分级，以及提高CVP对VAE的影响。
1 资料和方法
1.1 对象及分组
以2014年11月—2017年11月到我院就医拟在全麻下行后路椎体间融合术的166例病人为研究对象，其中男80例、女86例，年龄30～50岁，ASAⅠ～Ⅱ级。术前均无严重心肺疾病，肝肾功能无明显异常，均除外先天性心脏病及胃食管疾病病人。所有手术均由同一外科医生完成，手术处理两个节段的病变腰椎。本研究获医院伦理委员会批准，病人或家属签署知情同意书。采用随机数生成器将166例病人分成两组，奇数分配到对照组(n=82)，偶数分配到高CVP组(HCVP组，n=84)。, 百拇医药(刘文义 王俊环 徐晓林 徐敏 王曼睿 邵翠华)