| BackgroundHysteroscopic surgery is a relatively mature clinical diagnosis and treatment technology.Because the operation causes less trauma to the patients,it can reduce the pain of the patients,and the patients recover quickly after operation,which is widely carried out in clinic.Since the development of hysteroscopic resection,hysteroscopic surgery has been commonly used to treat submucosal uterine fibroids,endometrial polyps,uterine mediastinal deformities,abnormal uterine bleeding,and intrauterine adhesions,etc.Due to the relatively small operating space during hysteroscopic surgery,the uterine dilator needs to be used to expand the uterine cavity with a certain pressure to facilitate the inspection and operation of the hysteroscope.Uterine blood is abundant,under high pressure of the uterine dilatation machine,the opening of the blood sinus in the surgical area can easily cause the dilation fluid to enter the body from the wound,causing potential risks such as blood dilution,water and sodium retention,and even water poisoning.As one of the serious complications of hysteroscopic surgery,prevention is more important than treatment.At present,there are few methods for prevention and monitoring during hysteroscopic surgery.Most of them reduce the absorption of perfusate through measures such as reducing dilatation pressure and shortening the operation time.The methods that can be continuously monitored during surgery in the literature at home and abroad include central venous pressure monitoring and transthoracic pulmonary ultrasound,which cannot be operated by simple and easy methods.Due to the absorption of perfusion fluid in hysteroscopic surgery,the blood will be diluted to different degrees,and the human body can present a state of dilution anemia.Blood gas analysis can directly reflect the pathophysiological changes of human body caused by the absorption of perfusate,which is the most direct and accurate monitoring method.Studies have shown that when the concentration of hemoglobin decreases,the decrease of hemoglobin oxygen carrying capacity can lead to the imbalance of local oxygen supply and demand,increasing the damage to the organ.Cerebral oxygen saturation can reflect the balance of oxygen supply and demand in local brain tissue,which will decrease during excessive hemodilution and can be used as a means of monitoring during operation.Objective1.To investigate the effect of perfusion fluid absorption on blood gas during hysteroscopic surgery.2.By observing the changes of cerebral oxygen saturation and combining blood gas analysis,explore the application value of cerebral oxygen saturation in improving the safety of hysteroscopic surgery.Materials and methodsPatients who underwent submucous myomectomy in the second affiliated Hospital of Zhengzhou University from December 2018 to May 2019 were selected.A total of 40 patients,aged 25 to 40 years old and weighing 50 to 75 kg,ASA gradeⅠ～Ⅱ,were enrolled in the study.Exclusion criteria:patients with abnormal liver and kidney function,cardiopulmonary disease,severe anemia,and operation time less than 30 minutes or greater than 55 minutes.This study has been approved by the Medical Ethics Committee of our hospital.Patients and their families were informed and signed the informed consent for anesthesia.Routinely ban drink and food preoperative.Connected to a multifunctional monitor after entering the operating room,routinely monitor blood pressure(NIBP),electrocardiogram(ECG),heart rate(HR),pulse oxygen saturation(SpO2),body temperature,and continuously monitor brain oxygen saturation(rScO2).Open venous access.Anesthesia induction was performed routinely after preparation,the laryngeal mask was inserted 3min later,and the airway peak pressure(PIP)was monitored.Total intravenous anesthesia was used for intraoperative maintenance.Connect the perfusion device and adjust the pressure of the uterine uterus to 130mmHg.The uterine uterine medium is 0.9%sodium chloride.Venous blood was collected at the beginning of the operation(T1),20 minutes after the operation(T2),and at the end of the operation(T3),and recorded the hematocrit(Hct),hemoglobin(Hb),pH,and electrolytes.rScO2 was continuously monitored and values were recorded at three time points.Record the time of surgery and anesthesia,the amount of infusion during the operation.SPSS 21.0 statistical software was used for data processing.Normal distribution measurement data were expressed as mean ± standard deviation(x±S).Repeated measurement analysis of variance was used for comparison at different time points of the same measurement,and multiple comparisons within the group were performed using LSD-t test.Pairwise comparisons between groups were performed using paired t test.The correlation analysis between rScO2 and Hct,pH,Hb and body temperature indexes was performed using pearson correlation analysis.The difference was statistically significant at P<0.05.Results1.Compared with T1,Hct,Hb,pH,the concentrations of K+and Ca2+at T2 and T3 significantly decreased(P<0.05);compared with T2,Hct,Hb,pH,the concentrations of K+and Ca2+at T3 were significantly decreased(P<0.05).2.Compared with T1,PIP increased at T2 and T3(P<0.05);compared with T2,PIP increased at T3(P<0.05).3.Compared with T1,rScO2 decreased at T2 and T3(P<0.05);compared with T2,rScO2 decreased at T3(P<0.05).4.Compared with T1,body temperature at T2 and T3 decreased(P<0.05);compared with T2,body temperature at T3 decreased(P<0.05).5.Correlation analysis showed that rScO2 was not correlated with pH(P>0.05),and rScO2 had a positive correlation with Hb,Hct and body temperature(P<0.05).ConclusionsBlood gas analysis shows that significant hemodilution and electrolyte disturbances have occurred during hysteroscopic surgery,but blood gas analysis can only indicate changes in biochemical indicators,it cannot reflect the oxygen supply and demand balance of the body during dilution anemia.When combined with cerebral oxygen saturation monitoring,the safety of hysteroscopic surgery is improved,and it is of great significance to prevent brain damage caused by excessive absorption of perfusate. |
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