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医源性脑气体栓塞——病例报告的系统综述。

Iatrogenic cerebral gas embolism-A systematic review of case reports.

机构信息

Medical Faculty, University of Bergen, Bergen, Norway.

Haukeland University Hospital, Bergen, Norway.

出版信息

Acta Anaesthesiol Scand. 2019 Feb;63(2):154-160. doi: 10.1111/aas.13260. Epub 2018 Sep 10.

Abstract

BACKGROUND

Cerebral gas embolism is a complication of several medical procedures and occurs when gas enters the cerebral circulation. Knowledge about etiology and outcome in affected patients is limited, and prospective trials on management and treatment are hardly feasible. Case reports are therefore an important source of information.

METHODS

A systematic literature search was conducted in June 2016 and May 2018, supplemented by a manual search. Titles and abstracts were systematically assessed for eligibility, followed by full-text screening for included papers. Screening and data extraction were performed independently by two researchers. Cases of cerebral gas embolism due to any iatrogenic cause were included. Criteria for exclusion were: animal studies, non-cerebral localization, extravascular gas only, and non-iatrogenic causes. 264 cases reported in 189 papers were included.

RESULTS

A broad range of procedures leading to iatrogenic cerebral gas embolism (ICGE) were identified and a comprehensive list is presented in this article. Procedures were mostly reported as conducted correctly, but procedure related error, patient activity, or defective equipment were also reported as causes. Neurological, neuropsychological, and cardiopulmonary symptoms were common. The diagnosis was frequently based on or confirmed by radiology, usually CT. Hyperbaric oxygen therapy was applied in a large number of cases.

CONCLUSION

The reported causes, symptoms and signs, and outcomes of ICGE vary significantly, and awareness of the condition in the medical community is essential. A standardized method of reporting could facilitate higher quality research in the field.

摘要

背景

脑气体栓塞是几种医疗程序的并发症,发生于气体进入脑循环时。受影响患者的病因和预后知识有限,且管理和治疗的前瞻性试验几乎不可行。因此,病例报告是重要的信息来源。

方法

系统地检索了 2016 年 6 月和 2018 年 5 月的文献,并进行了手工检索。对标题和摘要进行了系统评估,以确定是否符合入选标准,然后对纳入的论文进行了全文筛选。筛选和数据提取由两名研究人员独立进行。纳入了因任何医源性原因导致的脑气体栓塞的病例。排除标准为:动物研究、非脑部定位、仅血管外气体和非医源性原因。在 189 篇论文中报道了 264 例病例。

结果

确定了导致医源性脑气体栓塞(ICGE)的一系列广泛的程序,并在本文中列出了一个全面的清单。这些程序大多被报道为正确进行,但也有报道称程序相关的错误、患者活动或设备缺陷也是导致气体栓塞的原因。神经学、神经心理学和心肺症状很常见。诊断通常基于或通过放射学(通常为 CT)证实。高压氧治疗在大量病例中应用。

结论

ICGE 的报告原因、症状和体征以及结果差异很大,因此医疗界对该病症的认识至关重要。标准化的报告方法可以促进该领域的高质量研究。

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