Yamaoka Ayumu, Miyata Kei, Narimatsu Eichi, Sakawaki Eiji, Sakawaki Sonoko, Hirayama Suguru, Uemura Shuji, Yama Naoya
Department of Emergency Medicine Sapporo Medical University Sapporo Hokkaido Japan.
Present address: Emergency Medical Center Hakodate Municipal Hospital 1-10-1 Minato-cho Hakodate 041-8680 Japan.
Acute Med Surg. 2017 Apr;4(2):213-216. doi: 10.1002/ams2.250. Epub 2016 Nov 10.
A 44-year-old man intentionally stabbed himself in the anterior neck and left thorax with a fruit knife. Physical examination revealed two open wounds entering the thoracic cavity in the front chest, and a stab wound entering the trachea at the neck. Two chest tubes were initially inserted for the left lung injury with open hemopneumothorax. Nevertheless, the worsening oxygenation required positive pressure ventilation (PPV) with endotracheal intubation.
Right hemiparesis was found during weaning from PPV. Magnetic resonance imaging revealed multiple infarctions in the area of the bifrontal and right temporal lobes. Cerebral air embolism (CAE) was strongly suspected from the imaging findings and clinical course.
We concluded that mechanical ventilation was strongly involved in the occurrence of CAE. If delayed abnormal neurological findings are observed in patients with penetrating lung injuries receiving PPV management, CAE should be considered.
一名44岁男性用水果刀故意刺伤自己的前颈部和左胸部。体格检查发现前胸有两处开放性伤口进入胸腔，颈部有一处刺伤进入气管。最初因左肺开放性血气胸损伤插入了两根胸管。然而，由于氧合情况恶化，需要进行气管插管并进行正压通气（PPV）。
在撤离PPV期间发现右侧偏瘫。磁共振成像显示双侧额叶和右侧颞叶区域有多处梗死。根据影像学表现和临床过程，强烈怀疑为脑空气栓塞（CAE）。
我们得出结论，机械通气与CAE的发生密切相关。对于接受PPV治疗的穿透性肺损伤患者，如果观察到延迟出现的异常神经学表现，应考虑CAE。
