Department of Cardiology, University of Copenhagen, Herlev Hospital, Herlev Ringvej, 100 DK-2730, Denmark.
Scand J Trauma Resusc Emerg Med. 2012 Aug 3;20:51. doi: 10.1186/1757-7241-20-51.
Venous gas embolism is common after laparoscopic surgery but is only rarely of clinical relevance. We present a 52 year old woman undergoing laparoscopic treatment for liver cysts, who also underwent cholecystectomy. She was successfully extubated. However, after a few minutes she developed cardiac arrest due to a venous carbon dioxide (CO2) embolism as identified by transthoracic echocardiography and aspiration of approximately 7 ml of gas from a central venous catheter. She was resuscitated and subsequently treated with hyperbaric oxygen to reduce the size of remaining gas bubbles. Subsequently the patient developed one more episode of cardiac arrest but still made a full recovery. The courses of events indicate that bubbles had persisted in the circulation for a prolonged period. We speculate whether insufficient CO2 flushing of the laparoscopic tubing, causing air to enter the peritoneal cavity, could have contributed to the formation of the intravascular gas emboli. We conclude that persistent resuscitation followed by hyperbaric oxygen treatment after venous gas emboli contributed to the elimination of intravascular bubbles and the favourable outcome for the patient.
静脉气体栓塞在腹腔镜手术后很常见，但通常无临床意义。我们报告了一位 52 岁女性，因肝囊肿接受腹腔镜治疗，同时还接受了胆囊切除术。她成功拔管。然而，几分钟后，经胸超声心动图和从中心静脉导管抽吸约 7 毫升气体证实她发生了静脉二氧化碳（CO2）栓塞，导致心脏骤停。她接受了复苏治疗，并随后接受高压氧治疗以减小剩余气泡的大小。随后，患者又发生了一次心脏骤停，但仍完全康复。事件过程表明，气泡在循环中持续存在了很长时间。我们推测腹腔镜管中 CO2 冲洗不足，导致空气进入腹腔，是否可能导致血管内气体栓塞的形成。我们得出结论，静脉气体栓塞后持续复苏和高压氧治疗有助于消除血管内气泡，并使患者获得良好的结局。
