Badreldin Akmal M A, Albert Alexander A, Ismail Mohamed M, Heldwein Matthias, Doerr Fabian, Bossert Torsten, Lichtenberg Artur, Hekmat Khosro
Department of Cardio-Thoracic-Surgery, Friedrich Schiller University of Jena, Jena, Germany.
Interact Cardiovasc Thorac Surg. 2010 May;10(5):766-9. doi: 10.1510/icvts.2009.228270. Epub 2010 Feb 12.
Gaseous embolism is a possible complication during off-pump coronary surgery with the use of a blower and can cause ischemic injuries. We describe two different possible mechanisms of carbon-dioxide embolization.
Out of 2196 coronary bypass surgeries, between 1 January 2007 and 31 December 2009, there were 977 off-pump operations. Two off-pump cases (0.2%) had gaseous (carbon-dioxide) emboli that migrated against blood stream proximally through T-anastomoses and then into the native coronary vessels. These emboli caused a temporary haemodynamic deterioration in other territories. Two types of T-anastomoses were included [saphenous vein on left internal thoracic artery (LITA) or right internal thoracic artery (RITA) on LITA].
Simple procedures and measurements were necessary but enough to regain haemodynamic stability. There was no effect on the postoperative outcome.
We have concluded that carbon-dioxide emboli can also cause massive but temporary haemodynamic deterioration during off-pump surgery despite higher solubility in blood. The blower should be used only when a bull-dog clamp is applied on the graft. Also, proper de-airing and flushing of grafts is very important and avoids consequences of the trapped small emboli.
气体栓塞是在使用鼓风装置的非体外循环冠状动脉手术过程中可能出现的并发症，可导致缺血性损伤。我们描述了二氧化碳栓塞的两种不同可能机制。
在2007年1月1日至2009年12月31日期间进行的2196例冠状动脉搭桥手术中，有977例是非体外循环手术。两例非体外循环病例（0.2%）出现气体（二氧化碳）栓子，这些栓子通过T形吻合口向近端逆流，然后进入自身冠状动脉血管。这些栓子导致其他区域出现暂时的血流动力学恶化。包括两种类型的T形吻合口[左胸廓内动脉（LITA）上的大隐静脉或LITA上的右胸廓内动脉（RITA）]。
简单的操作和测量是必要的，但足以恢复血流动力学稳定性。对术后结果没有影响。
我们得出结论，尽管二氧化碳在血液中的溶解度较高，但在非体外循环手术期间，二氧化碳栓子也可导致严重但暂时的血流动力学恶化。仅当在移植物上应用弹簧夹时才应使用鼓风装置。此外，对移植物进行适当的排气和冲洗非常重要，可避免被困小栓子带来的后果。
