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婴儿腹腔镜幽门肌切开术中气体栓塞和心脏骤停。

Gas embolus and cardiac arrest during laparoscopic pyloromyotomy in an infant.

机构信息

Department of Pediatric Anesthesiology, Children's Hospital of Wisconsin, Milwaukee, USA.

出版信息

Can J Anaesth. 2010 Aug;57(8):774-8. doi: 10.1007/s12630-010-9320-6. Epub 2010 Apr 30.

Abstract

PURPOSE

High volume tubing is used to deliver carbon dioxide during laparoscopic procedures. Failure to prime the tubing with carbon dioxide prior to abdominal insufflation may result in the delivery of nitrogen-containing air to the abdominal cavity. We report a case in which initial insufflation of laparoscopic gas resulted in immediate cardiovascular collapse requiring prolonged resuscitation. Persistent intracranial emboli following the arrest may have resulted from nitrogen contamination of the delivered gas.

CLINICAL FEATURES

A 12-day-old female underwent laparoscopy for pyloric stenosis. During initial insufflation of the abdomen, the patient had an abrupt decrease in end-tidal carbon dioxide (CO(2ET)) associated with bradycardia and pulseless electrical activity. Three hours after successful resuscitation and open pyloromyotomy, computerized tomography documented intra-arterial gas within the cerebral and hepatic circulations that resolved following hyperbaric oxygen therapy. Magnetic resonance imaging five days later revealed watershed infarcts in the right frontal and parietal regions. Nitrogen, an insoluble gas not easily eliminated from the body, was likely the gas present within the patient's circulation several hours after the event. It was unlikely carbon dioxide, which is a highly soluble gas that binds to hemoglobin and is rapidly buffered by the carbonic anhydrase system and excreted by the lung. Room air contamination of high volume insufflation tubing allows nitrogen to enter body cavities during endoscopic procedures.

CONCLUSION

Persistence of emboli following endoscopic procedures suggests that the entrained gas is insoluble. Room air contamination increases the potential for catastrophic events during laparoscopy and other endoscopic procedures.

摘要

目的

在腹腔镜手术中,使用大流量管输送二氧化碳。如果在腹部充气前未用二氧化碳对管进行预充,可能会导致向腹腔输送含氮空气。我们报告了 1 例初始腹腔镜气体充气导致心血管立即崩溃,需要长时间复苏的病例。停搏后持续的颅内栓子可能是由于输送气体受到氮污染所致。

临床特征

一名 12 天大的女性因幽门狭窄而行腹腔镜检查。在腹部初始充气时,患者的呼气末二氧化碳(CO2ET)突然下降,伴有心动过缓和无脉性电活动。成功复苏和剖腹切开幽门肌后 3 小时,计算机断层扫描显示脑和肝循环内有动脉内气体,高压氧治疗后消失。5 天后磁共振成像显示右侧额顶叶分水岭梗死。氮气是一种不易从体内排出的不溶性气体,很可能是在事件发生数小时后存在于患者循环中的气体。不太可能是二氧化碳,因为二氧化碳是一种高度可溶性气体,与血红蛋白结合,并被碳酸酐酶系统迅速缓冲,通过肺部排出。大量充气管的室内空气污染会导致氮气在内镜手术期间进入体腔。

结论

内镜手术后栓子的持续存在表明所夹带的气体是不溶性的。室内空气污染增加了腹腔镜和其他内镜手术期间发生灾难性事件的可能性。

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