摘要
目的 探讨全膝关节置换术（TKA）中应用经食管超声心动图（TEE）实时监测心腔脂肪栓子的技术方法及意义.方法 11例12膝骨性关节炎（OA）老年女性患者.10例行左侧TKA,1例行双侧TKA.根据是否应用止血带随机分为止血带组（6膝）及对照组（6膝）.采用多平面TEE对整个手术过程进行连续动态监测.观察TKA各时期心腔有无脂肪栓子及其声像图特点.结果 所有患者在TKA各时期均观察到自下腔静脉流入右心房的点线状、阵雨样脂肪栓子回声.大多呈中等回声或强回声.而左心系统全程均未见类似回声.两组在股骨扩髓即刻至扩髓后3 min,右心房栓子回声数量较其他各时期显著增多,回声强度增高;止血带组在释放止血带瞬间至释放后5 min.均可见大量栓子回声呈＂暴风雪样＂进入右心系统.且至TEE监测末期仍能观察到比对照组峰值时期更多的栓子.结论 TKA中应用TEE实时监测有助于直观观察心腔内脂肪栓子的超声影像学特征.有利于亚临床型脂肪栓塞综合征（FES）的早期诊断和干预.
Objective To detect fat emboli in cardiac chamber of the patients undergoing total knee arthroplasty（TKA） by transesophageal echocardiography（TEE）, and to discuss the relevant clinical value.Methods Eleven female patients with 12 osteoarthritis（OA） knees were underwent TKA. According to whether using tourniquet or not,12 knees were divided into 2 groups at random：tourniquet-related group （6 knees） and control group（6 knees）. Echo intensity and ultrasonic characteristics of fat emboli in cardiac chamber were studied dynamically by multiplane TEE in various periods of the whole operation. Results All of the patients were implanted knee prostheses successfully. In different periods of TKA, fat emboli appeared as isoechoic or hyperechoic particles, which were found in right atrium, but nothing could be found in left heart. The imaging of the particles was flowing with duration time of 10～600s, like dots, lines, ＂moving star＂ or ＂shower＂. While femur expanding（0～3mins）,the particles in right atrium and ventricle became more and more, and the echo intensity became significantly higher than those in other periods. After releasing tourniquet（0～5mins）,most particles with highest echo intensity were observed in right heart,showing like ＂snowstorm＂ in tourniquet-related group, and more emboli were still detected at the end of monitoring （10 min after releasing tourniquet） by TEE,compared to the control group. No patient suffered from fat embolism syndrome（FES） with clinical manifestation. Conclusions Fat emboli in cardiac chamber can be observed sensitively by real-time TEE dynamically during TKA. It should be encouraged and promoted to analyze ultrasonic characteristics to facilitate the early detection, early diagnosis and early clinical intervention for the subclinical type of FES.
出处
《中华超声影像学杂志》
CSCD
北大核心
2010年第12期1035-1038,共4页
Chinese Journal of Ultrasonography
关键词
超声心动描记术
经食管
关节成形术
置换
膝
栓塞
脂肪
Echocardiography, transesophageal
Arthroplasty, replacement, knee
Embolism, fat
