坐位麻醉中反常栓塞病例报道1例.docVIP

坐位麻醉中反常栓塞病例报道1例 首都医科大学北京宣武医院麻醉科 100053 叶新 马挺 葛明非 王天龙 Abstract Background: The authors report 1 cases of air embolism through patent foramen ovale (PFO) into the left atrial in the sitting position . Case Description: A 36-year-old woman weighing 52 kg was admitted to neurosurgical ward. Computed tomography showed a 3.5 × 3 × 2.5-cm posterior fossa lobulated mass. A diagnosis of posterior fossa neuroma epidermoid was made, and the patient was scheduled for elective right suboccipital craniotomy and tumor excision in the sitting position . Her medical history was unremarkable, and routine preoperative examination results were normal. She was fully conscious, oriented. Then a transesophageal echocardiographic (TEE) monitor probe was positioned to detect venous air embolism (VAE). Intraoperation we were able to observe air embolism through patent foramen ovale (PFO) into the left atrium by TEE. Aspiration of the bubbles was immediately started from the central catheter placed in the right subclavian vein and the catheter tip positioned at the junction of the superior vena cava and right atrium. Postoperatively, the patient showed no neurologic sequelae and discharged from hospital. Conclusions: The incidence of TEE-detected VAE is 100% during posterior fossa surgery performed with the patient in the sitting position. The TEE monitor can show air bubbles entering the left atrium through patent foramen ovale (PFO).TEE is an essential monitoring technique during posterior fossa surgery in the sitting position. Keywords: anaesthesia, neurosurgical；patent foramen ovale (PFO)；TEE；The sitting position 摘要 背景：报道1例坐位麻醉中空气栓塞经卵圆孔进入左心房。 病例概述：女性病人，36岁，右桥小脑角脑膜瘤，09.3.5坐位下行右枕下乙状窦后入路桥小脑角脑膜瘤切除术。术前患者无其他系统合并症，意识，定向力正常。术中行经食道超声心动图监测，发现静脉空气栓塞经卵圆孔进入左心房，术后病人恢复良好出院。 结论：坐位手术中常合并出现静脉空气栓塞，空气栓子可经过卵圆孔进入左心房，经食道超声心动图可及时发现栓子。因此经食道超声心动图应为坐位手术的必须监测技术。 关键词 神经外科麻醉；静脉空气栓塞；经食道超声心动图；坐位 介绍 因为严重的并发症如静脉空气栓塞，血液动力学不稳定，气颅，喉水肿，神经损伤，坐位在神经外科手术中是最有争议的体位。这种体位在1913 年由Demertal首先引入神经外科, 1928年Frazier在美国推广