Ramirez L, Hummel V, Marsaud J P, Valgueblasse V, Nathan N, Pichon N
Service d'anesthésie-réanimation, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
Ann Fr Anesth Reanim. 2012 Sep;31(9):724-7. doi: 10.1016/j.annfar.2012.04.003. Epub 2012 Jun 29.
The authors report the first case of gas embolism arising during an upper gastrointestinal endoscopy to a patient carrier of a biliary drain placed by radiological way. The hypothesis of a biliary-vascular fistula with abnormal connection between the biliary tree and the hepatic vascular system and finally an arteriovenous intrapulmonary shunt was retained to explain the physiopathology. The immediate stop of the endoscopic procedure and the implementation of symptomatic treatment allowed a favorable neurological outcome without sequelas. The realization of an upper gastrointestinal endoscopy to a patient carrier of a biliary drain has to lead the anaesthesiologists and the gastroenterologists to take care given the incurred risk of gas embolism.
作者报告了首例在对一名通过放射方式放置胆管引流管的患者进行上消化道内镜检查时发生气体栓塞的病例。为解释其病理生理过程，保留了胆管与肝血管系统之间存在异常连接的胆-血管瘘以及最终导致肺内动静脉分流的假说。内镜检查的立即停止及对症治疗的实施使患者获得了良好的神经学转归且无后遗症。鉴于存在气体栓塞的风险，对携带胆管引流管的患者进行上消化道内镜检查时，麻醉医生和胃肠病医生必须格外小心。
