Kahn J K, Hartzler G O
Cardiovascular Consultants, Inc., Mid America Heart Institute, Kansas City, MO.
Am Heart J. 1990 Jun;119(6):1374-7. doi: 10.1016/s0002-8703(05)80188-7.
PTCA is a widely used method of myocardial revascularization. Although complications of this procedure have been characterized, air emboli to the coronary vasculature have rarely been reported and their appropriate management is uncertain. We report six cases of symptomatic coronary air emboli occurring during PTCA. The possible mechanisms of the introduction of air during PTCA include incomplete aspiration of guiding catheters, balloon rupture, insinuation of air with balloon catheter introduction or withdrawal; structural failures of the equipment, and constant negative suction of selfventing catheters left outside the body. Symptomatic responses range from mild angina to full cardiac arrest and tend to resolve spontaneously in 5 to 10 minutes. Treatment is aimed at supporting the patient for this brief period, and consists of 100% inspired oxygen, analgesics, arrhythmic therapy if needed, and pressor and balloon pump support as required. Greater awareness of the causes, prevention, and therapy of coronary air emboli will lead to the safer practice of PTCA.
经皮冠状动脉腔内血管成形术（PTCA）是一种广泛应用的心肌血运重建方法。尽管该手术的并发症已有描述，但冠状动脉血管空气栓塞很少被报道，且其恰当的处理方法尚不确定。我们报告了6例PTCA术中发生有症状冠状动脉空气栓塞的病例。PTCA术中空气进入的可能机制包括引导导管抽吸不完全、球囊破裂、球囊导管插入或拔出时空气潜入；设备结构故障，以及体外留置的自排气导管持续负压吸引。症状反应从轻度心绞痛到完全心脏骤停不等，且往往在5至10分钟内自行缓解。治疗旨在在此短时间内支持患者，包括吸入100%氧气、使用镇痛药，如果需要可进行心律失常治疗，并根据需要给予升压药和球囊泵支持。提高对冠状动脉空气栓塞的病因、预防和治疗的认识将使PTCA的操作更安全。
