Comparison of volume therapy guided by inferior vena cava ultrasound and lung ultrasound at different sites in patients undergoing grade four hysteroscopic surgery / 中华麻醉学杂志

ABSTRACT

Objective:To compare the efficacy of volume therapy guided by inferior vena cava ultrasound and lung ultrasound at different sites in patients undergoing grade four hysteroscopic surgery.Methods:A total of 90 patients, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classificationⅠ or Ⅱ, undergoing elective grade four hysteroscopic surgery under general anesthesia, were divided into 3 groups ( n=30 each) using a random number table method: conventional group (C group), ultrasound at the subcostal area group (S group) and ultrasound at right mid-axillary line group (R group). When the inferior vena cava distensibility index<15% or pulmonary ultrasound B-line score>8.5 or arterial blood gas Na + concentrations <125 mmol/L, surgeons were advised to speed up the process of surgery and decrease the pressure of uterine distention, furosemide 10-20 mg was intravenously injected, and the speed of infusion was adjusted at the same time.On admission to the operating room (T 0), at 20 min after induction (T 1), 40 min after induction (T 2), and at the end of operation (T 3), the B-line score of lung ultrasound, concentrations of Lac and Na + and PaO 2/FiO 2 were recorded, and the postoperative complications, amount of uterine distention fluid, volume of fluid infused and time of laryngeal mask airway removal were recorded. Results:Compared with group C, the pulmonary ultrasound B-line score was significantly decreased, the concentrations of Na + and PaO 2/FiO 2 were increased, the time of laryngeal mask airway removal was shortened, and the amount of uterine distention fluid was decreased in S and R groups, and the total incidence of complications was significantly decreased in group R ( P<0.05). Compared with group S, the lung ultrasound B-line score was significantly decreased, PaO 2/FiO 2 was increased, and the amount of uterine distention fluid was decreased in group R ( P<0.05). Conclusions:Compared with subxiphoid process, the volume therapy guided by inferior vena cava ultrasound on the right mid-axillary line and lung ultrasound has more advantages in the patients undergoing grade four hysteroscopic surgery.