Benson J, Adkinson C, Collier R
Hyperbaric Medicine, Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Undersea Hyperb Med. 2003 Summer;30(2):117-26.
We describe our experience using HBO2 therapy for iatrogenic cerebral arterial gas embolism (CAGE) in this retrospective review of nineteen patients treated for iatrogenic CAGE, from 1987 to 1999. Immediately after treatment, five patients completely resolved all signs and symptoms, eleven had improvement, one had no change, and two were not assessable. Within two months post treatment, three additional patients completely resolved and six had further improvement. Patients with a venous source all experienced pulmonary signs or symptoms, with eight of nine chest x-rays demonstrating pulmonary edema. Patients with an arterial source had no pulmonary symptoms; all chest x-rays were clear. Imaging studies prior to HBO2 therapy demonstrated gas in six of 23 exams; five of the remaining 17 exams showed secondary changes consistent with gas embolism. Iatrogenic CAGE patients improved with HBO2 therapy, and improvement for some continued for several months. Patients with CAGE from a venous source have pulmonary signs or symptoms. Diagnosis of CAGE should be made on clinical suspicion without reliance on imaging studies.
在这项对1987年至1999年间接受医源性脑动脉气体栓塞（CAGE）治疗的19例患者的回顾性研究中，我们描述了使用高压氧（HBO2）疗法治疗医源性CAGE的经验。治疗后立即有5例患者的所有体征和症状完全消失，11例有所改善，1例无变化，2例无法评估。治疗后两个月内，又有3例患者完全康复，6例进一步改善。静脉源性患者均出现肺部体征或症状，9例胸部X光片中8例显示肺水肿。动脉源性患者无肺部症状；所有胸部X光片均清晰。HBO2治疗前的影像学检查在23次检查中有6次显示有气体；其余17次检查中有5次显示与气体栓塞相符的继发改变。医源性CAGE患者接受HBO2治疗后有所改善，部分患者的改善持续了数月。静脉源性CAGE患者有肺部体征或症状。CAGE的诊断应基于临床怀疑，而不依赖于影像学检查。
