Clinical manifestations of the patient during surgery:
Pulmonary edema: chest tightness, shortness of breath, cough, cough, pink foam sputum, and moist rales can be heard in the lungs;
Brain edema: manifested as irritability, nausea, headache, Blurred vision, Disorders of consciousness, etc;
If there is renal insufficiency, it can cause oliguria or anuria;
Reduced blood sodium;
Elevated blood sugar (using 5% glucose for dilation fluid).
Prevention of Water intoxication
Before surgery, the patient should carefully inquire about their medical history, conduct a comprehensive evaluation, consider the shape of the cervix and uterine cavity, the size, location, and relationship with the myoma in the uterine cavity, potential postoperative complications, the selection of type of dilation fluid, the selection of dilation pressure, the prediction of the amount of dilation fluid used, and the completion time of the manual surgery. Patients who do not tolerate surgery should be corrected before surgery is performed.
Common electrolyte mediums include normal saline, Sodium lactate Ringer solution, 5% sugar saline, etc. Non electrolytes include 5% glucose, 5% Mannitol, etc.
The dilation pressure is the most important variable factor affecting the absorption of perfusion fluid. Setting the dilation pressure below 80mmHg during hysteroscopic surgery can usually prevent bleeding from breaking blood vessels and the absorption of perfusion medium, without any complications; The pressure of uterine dilation increases, even if the absorption of perfusion fluid is within the normal range.
There is a very close relationship between surgical time and the occurrence of risks. The longer the surgical time, the greater the probability of risks. Strictly control the surgical time within 1 hour, and remind the doctor every half an hour. For hysteroscopic surgery with large muscle wall damage and excessive bleeding, a second surgery can be performed without the need to complete it at once.
Early stage: the patient has chest tightness and discomfort, the transient heart rate is less than 60 times/minute, SPO is less than 95%, and middle stage: the patient has headache, nausea, vomiting, irritability, coughing white foam sputum, and facial edema. Blood pressure drops, P<60 times 1 minute, SPO<90%, late stage: shock occurs, P<60 times 1 minute, SPO<85%, and the patient presents with a series of clinical symptoms such as mental fatigue, apathy, and delayed response. Proper treatment should be taken according to the patient's situation.
In order to effectively avoid the occurrence of Water intoxication, preoperative evaluation of surgical risks should be carried out, and high-risk factors should be pretreated in advance, so as to prevent problems before they occur. During the operation, the distention pressure and the type of distention medium should be properly selected, and the operation time and the amount of distention liquid should be strictly controlled. The infusion liquid should be prevented from being excessively absorbed in a short time. At the same time, the electrolyte concentration level during the operation should be closely monitored to keep the patient awake during anesthesia, so as to facilitate the observation of the condition, Timely discover, timely diagnose and timely handle, so as to minimize the risk of surgery and effectively prevent Water intoxication in hysteroscopic surgery from endangering the lives of patients.