As technology continues to develop a lot, medical technology is also constantly improving. We all know that the most important thing for a person is good health, so as to ensure a happy life. Many women will undergo hysteroscopic surgery. This kind of surgery also has some effects on women. Some women will accidentally be infected with hysteroscopic surgery water. So what are the prevention and treatment measures for hysteroscopic surgery water poisoning? Hysteroscopy Preventive and treatment measures for surgical water intoxication
Uterine perforation
Uterine perforation (instrument entering the abdominal cavity) and uterine rupture may be caused by excessive uterine expansion pressure and rapid expansion of the uterine muscle wall during surgery. Thinning is the result of the same effect. When the uterine cavity is expanded, the thickness of the uterine wall can be less than 1 cm. Therefore, the setting of the uterine distension pressure during hysteroscopic resection should be the minimum pressure that meets the visual field, which is generally the mean arterial pressure level. When the uterine wall is thin enough, the normal level of uterine distension pressure may break through the integrity of the uterine wall. sex, leading to perforation or uterine rupture.
Precautionary measures: The tissue should not be resected too deep under hysteroscopy. At the same time, repeated operations on the same area of ??the uterus, especially the fundus and horns, should be avoided. If necessary, intraoperative ultrasound or laparoscopic monitoring can avoid this. Complex uterine cavity operations lead to the risk of uterine rupture or perforation.
TURP syndrome
Due to the effects of uterine expansion pressure and perfusion medium during hysteroscopic surgery, large amounts of perfusion fluid are absorbed, causing fluid overload and/or dilutional hyponatremia. It causes a series of clinical symptoms, with an incidence rate of 0.1 to 0.2. If not diagnosed and treated in time, it can lead to death. It is one of the serious complications in hysteroscopic surgery. Unipolar resection uses non-electrolyte perfusate, which is rapidly absorbed in large amounts and leads to fluid overload and dilutional hyponatremia. Bipolar electrosurgical resection uses normal saline perfusion. However, rapid absorption of large amounts still leads to the risk of hypervolemia and water intoxication. Long operation time, excessive uterine distension pressure, open sinusoids, and severed small arteries are risk factors for TURP syndrome. Reducing intrauterine pressure will result in poor or incomplete vision. Excessive intrauterine pressure can cause excessive fluid to seep into blood vessels. Once water intoxication is diagnosed, fluid intake should be stopped immediately and the underlying disease should be actively treated.
1. For mild cases, limit water intake.
Record the water intake and output in 24 hours, so that the water intake is less than the urine output. Or diuretics may be added appropriately, with loop diuretics such as enenic acid (diuretic acid) and furosemide being the first choice.
2. Acute and severe cases of excessive water intake and water intoxication
Treatment should be aimed at protecting heart and brain function and at dehydration and/or correcting hypoosmosis.
(1) High volume syndrome is mainly caused by dehydration, which reduces the load on the heart. Loop diuretics such as furosemide or ethacrynic acid are preferred. For patients with insufficient effective circulating blood volume, attention should be paid to supplementing the effective blood volume. Critical cases can be treated with blood ultrafiltration. If it is clear that there is excessive secretion of antidiuretic hormone, in addition to the treatment of the cause, lithium carbonate and diuretics can be used for treatment. Vasodilators such as sodium nitroprusside and nitroglycerin can be used to protect the heart and reduce cardiac load.
(2) People with hypotonicity (especially those who have developed psychoneurological symptoms) should quickly correct the intracellular hypotonic state. In addition to water restriction and diuresis, 3 to 5 sodium chloride solutions should be used. Closely observe changes in the condition such as cardiopulmonary function and adjust the dose and speed. It is generally appropriate to replenish the medicine in batches. Diuretics can be used simultaneously to reduce blood volume. Pay attention to correct potassium metabolism disorders and acidosis. Symptoms of hysteroscopic water intoxication
The symptoms of hysteroscopic water intoxication include pulmonary edema: chest tightness, shortness of breath, cough, pink frothy sputum, wet rales in the lungs, etc., and cerebral edema. Symptoms include irritability, nausea, headache, blurred vision, disturbance of consciousness, etc. If there is renal insufficiency, it may cause oliguria or anuria, decreased blood sodium, and increased blood sugar. However, generally there will be no poisoning in hysteroscopy water, so do not overdo it. Worry.
Hysteroscopy or surgery may cause water intoxication.
Water intoxication is mainly caused by the rupture of the uterine venous sinus, which causes a large amount of lavage fluid to enter the blood. It is caused by long operation time and high perfusion pressure. Generally, it can return to normal after treatment during and after the operation (hypertonic saline infusion, intravenous furosemide injection). , leaving no sequelae. Hysteroscopic water intoxication is a difficult problem for us to deal with in clinical work. Its mechanism is the same as transurethral resection of the prostate syndrome (TURP syndrome) in urology department. Its incidence rate is 0.1 to 0.2, and it can lead to death if it is not diagnosed and treated in time. The main clinical manifestations of water intoxication include:
① Pulmonary edema: manifested as chest tightness, shortness of breath, cough, pink frothy sputum, wet rales in the lungs, etc.;
② Cerebral edema: manifested as irritability, nausea, headache, blurred vision, disturbance of consciousness, etc.;
③If there is renal insufficiency, it may cause oliguria or anuria;
④Hematuria Decreased sodium;
⑤ Increased blood sugar (use 5-glucose as the uterine distending solution).