Abnormal echogenic findings detected by transesophageal echocardiography and cardiorespiratory impairment during total knee arthroplasty with tourniquet
Abnormal echogenic findings detected by transesophageal echocardiography and cardiorespiratory impairment during total knee arthroplasty with tourniquet
复制标题
DOI：
10.1097/00000542-200211000-00014
复制
发表时间：
2002-11-01
期刊：
影响因子：
8.8
通讯作者：
Ogawa, R
中科院分区：
文献类型：
--
作者：
Kato, N;Nakanishi, K;Ogawa, R
背景资料：在接受全膝关节置换术的患者中，术中肺栓塞事件很少见，大多数发生在止血带放气后。这种栓塞可以通过经食管超声心动图观察到。然而，作者遇到了动脉氧分压突然下降，而止血带仍在充气。因此，目前的调查的目的是在止血带充气阶段检测栓塞，并确定回声material.Methods的组成：46例患者被随机分配到接受全膝关节置换术没有（对照组，n = 24）或止血带（n = 22）。在全膝关节置换术过程中进行了血流动力学监测、血气分析和连续经食管超声心动图。当心房内有回声时，采集右颈静脉血。在止血带组中，27%的患者在股骨扩髓期间发生栓塞事件，止血带放气后100%发生栓塞事件。在对照组中，54%的患者在股骨扩髓期间检测到栓塞。大多数患者在重度回声栓塞后表现出心肺功能障碍，即使在止血带充气时也是如此（2例患者）。从中心静脉导管中抽取的血液样本均未检出可检测物质。这项前瞻性研究表明，栓塞事件发生在全膝关节置换术期间，即使在止血带充气的情况下。充气止血带不能完全防止肺栓塞。
Background: In patients undergoing total knee arthroplasty, intraoperative pulmonary embolic events are rare, and most occur following tourniquet deflation. This embolization can be observed using transesophageal echocardiography. However, the authors have encountered sudden decreases in arterial oxygen partial pressure while a tourniquet is still inflated. Therefore, the current investigation was designed to detect emboli during the tourniquet inflation phase and to identify the composition of the echogenic material.Methods: Forty-six patients were randomly assigned to undergo total knee arthroplasty without (control, n = 24) or with a tourniquet (n = 22). Hemodynamic monitoring, blood gas analysis, and continuous transesophageal echocardiography were performed during the total knee arthroplasty procedure. Right jugular blood specimens were collected whenever echogenic material was seen in the atrium.Results. In the tourniquet group, embolic events occurred in 27% of patients during femoral reaming and in 100% after tourniquet deflation. in the control group, emboli were detected in 54% of patients during femoral reaming. Most of the patients exhibited cardiopulmonary impairment after severe echogenic embolism, even while the tourniquet was inflated (two patients). None of the blood samples aspirated from the central catheters contained detectable material.Conclusions. This prospective study showed that embolic events occurred during total knee arthroplasty, even while a tourniquet was inflated. An inflated tourniquet does not completely prevent pulmonary emboli.