摘要
目的经食管超声心动图观察猪脂肪栓塞模型和全髋置换术中心腔内脂肪栓子的声像图特点。方法经猪颈内静脉依次缓慢注入0.1～12．0ml的同种脂肪液，用经食管超声心动图连续观察心腔内图像变化，记录脂肪栓塞的致死量。22例全髋置换术患者术中行经食管超声心动图检查，观察术中不同时期右心房脂防栓子的表现并定量分析其平均灰阶值和超声强度。结果①在脂肪栓塞模型中，脂肪栓子表现为游动的点状强回声，可呈星点状、阵雨或雪花飞舞状，脂肪注入量大于4ml后可出现反常栓塞，累积致死量为15．8～27．8ml；②全髋置换术的各个时期均可观察到右心房呈点状强回声的脂肪栓子。B期右心房的平均灰阶值和超声强度较其他各期增大（P〈0．05）。结论经食管超声心动图可敏感发现心腔内的脂肪栓子，术中监测并定量分析有助于诊断脂肪栓塞综合征，反常栓塞的出现是脂肪栓塞综合征的可靠证据。
Objective To observe the characterization of fat emboli in cardiac chamber in pig model and the patients undergoing total hip arthroplasty （THA） by transesophageal echocardiography （TEE）. Methods Different dose of fatty liquid was injected slowly via the internal jugular vein. The changes of the image were observed by continuous TEE. The lethal dose of fat embolism was recorded. Twenty two patients underwent TEE during THA. Gray scale and echo intensity of fat embolism in right atrium were studied quantitatively in varied periods of the operation. Results ①With the increase of fat liquid injected in pig model, the strong- echo particles in right atrium and ventricle became more and more, the imaging of the particles was from ＂moving star＂, ＂shower-like＂ to ＂snow fluffy＂, at last paradoxical fat embolism occurred when the dose of fat liquid was over 4 ml. The accumulated lethal dose of fat embolism was 15.8-27.8 ml. ②Fat emboli appeared as strong- echo particles in right atrium were found in different period of THA. Average gray scale and echo intensity of emboli in right atrium were significantly higher in period B than in other periods during THA. Conclusions Fat emboli in cardiac chamber can be found sensitively by TEE. Intra-operative monitoring and quantitative analysis is helpful to identifying fat embolism syndrome. Paradoxical embolism is a reliable evidence of fat embolism syndrome.
出处
《中华超声影像学杂志》
CSCD
2006年第12期892-894,共3页
Chinese Journal of Ultrasonography
关键词
超声心动描记术
经食管
栓塞
胆固醇
关节成形术
置换
髋
Echocardiography, transesophageal
Fat embolism, cholesterol
Arthroplasty, replacement
Hip
