| Background:Recently,the increase of cesarean section rate in China has led to the increase of perinatal complications of pregnant women.Embolism has been reported from time to time,It’s still one of the main causes of death in pregnant women.It increases the possibility of various rare but dangerous acute embolism events,such as amniotic fluid embolism and venous thromboembolism.At present,it has been found that esophageal echocardiography(TEE)can find massive emboli in inferior vena cava and right heart cavity in amniotic fluid embolism,but it lacks TEE’s detection of microemboli in patients during cesarean section without amniotic fluid embolism.In this study,TEE was used to reveal the clinical characteristics of microemboli in the cardiac cavity of patients during cesarean section,such as incidence,occurrence time,degree and right heart function.Methods: We choose 31 patients underwent cesarean section under general anesthesia in our hospital from November 2018 to March2022.The ASA grade was I or II,and they had general anesthesia indications such as contraindications to spinal anesthesia.Exclusion criteria: cardiopulmonary diseases;absolute or relative contraindications of TEE examination,such as esophageal diseases.TEE was used to continuously monitor the four-chamber transection plane(ME 4C)of the middle esophagus,and the incidence,grade of microemboli and right heart function were recorded at the beginning of operation,fetal delivery,placenta delivery and the end of operation,and the hemodynamic changes at each time point were also recorded.SPSS22.0 software was used for statistical analysis.Normal distribution measurement data were expressed by mean standard deviation,repeated measurement data variance analysis was used,and LSD method was used for pairwise comparison within the group.The data were tested by Friedman M test of several related samples,and Bonferroni multiple comparison method was used for pairwise comparison between groups.The data were compared by χ2 test or Fisher exact probability test.P<0.05 is statistically significant.Result:This study observed a total of 31 patients.The age,weight and gestational weeks of all parturients were in accordance with the normal distribution,and there was no significant difference.With continuous observation by transesophageal echocardiography(TEE),transient "snow-like" microemboli images can be observed in the right atrium,and then enter the pulmonary circulation,and no mass embolus is found.Compared with the beginning and end of the operation,the incidence of microembolism in the heart cavity of parturient women during fetal delivery and placenta delivery was significantly higher(P <0.05).The EF value of right ventricular 2D data at the time of fetal delivery was significantly lower than that at the end of operation(P <0.05),and there was no significant difference in FAC and TAPSE of right ventricular 2D data from the beginning of operation to the end of operation.Compared with the basic value of admission,systolic blood pressure and diastolic blood pressure increased significantly at the beginning of operation,and decreased significantly at 5 ～ 30 minutes after placenta delivery(P < 0.05).Sp O2 was higher than that of admission at all time points(P < 0.05),and there was no significant difference in heart rate at all time points.Conclusion: Microembolism in the cardiac cavity of cesarean section mainly occurs during fetal delivery and placenta delivery,which has a negative impact on EF value of four-dimensional data of right ventricle and blood pressure of patients,and should be paid attention to by anesthesiologists and surgeons. |
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