Vartikar J V, Johnson M D, Datta S
Brigham and Women's Hospital, Boston, MA 02115.
Reg Anesth. 1989 May-Jun;14(3):145-8.
Venous air embolism (VAE) is a potential but rare complication of cesarean delivery that can be associated with morbidity and death. Uterine sinuses are susceptible to the entrance of air during cesarean delivery. To define the incidence of VAE and its relation to arterial oxygen saturation (SaO2) and consequent electrocardiographic (ECG) changes, a prospective study was undertaken in which precordial Doppler monitoring was conducted during cesarean delivery. Concomitant, SaO2 and ECG were recorded in 78 patients. Fifty-one of 78 (65%) of the subjects had Doppler changes consistent with VAE. Of these, 37 patients (72%) showed a decreased SaO2, (average decline 5.2%). The remainder of the patients with Doppler changes showed no SaO2 change. Twenty of the patients with Doppler changes and decreased SaO2 complained of chest pain and dyspnea. Three of these patients exhibited ECG changes including ST segment depression. Although all ECG changes resolved spontaneously without sequelae, the potential clearly existed for life threatening embolic events. Thus, precordial Doppler monitoring of cesarean delivery patients demonstrated a surprisingly high incidence of Doppler changes consistent with VAE. Some episodes were associated with a significant reduction in SaO2 and rarely with ECG changes.
静脉空气栓塞（VAE）是剖宫产潜在但罕见的并发症，可能与发病和死亡相关。剖宫产过程中子宫窦易进入空气。为确定VAE的发生率及其与动脉血氧饱和度（SaO2）及随之而来的心电图（ECG）变化的关系，进行了一项前瞻性研究，在剖宫产过程中进行心前区多普勒监测。同时记录了78例患者的SaO2和ECG。78例受试者中有51例（65%）出现与VAE一致的多普勒变化。其中，37例患者（72%）的SaO2下降（平均下降5.2%）。其余有多普勒变化的患者SaO2无变化。20例有多普勒变化且SaO2下降的患者主诉胸痛和呼吸困难。其中3例患者出现ECG变化，包括ST段压低。尽管所有ECG变化均自发缓解且无后遗症，但显然存在危及生命的栓塞事件的可能性。因此，对剖宫产患者进行心前区多普勒监测显示，与VAE一致的多普勒变化发生率惊人地高。一些发作与SaO2显著降低相关，很少与ECG变化相关。
