Sato S, Toya S, Ohira T, Mine T, Greig N H
J Neurosurg. 1986 Mar;64(3):440-4. doi: 10.3171/jns.1986.64.3.0440.
A real-time two-dimensional echocardiogram was used to detect the presence of an air embolism in patients undergoing neurosurgical procedures in the sitting position. The technique could with good sensitivity detect the appearance of a single air bubble intraoperatively, thus allowing early intervention to prevent development of further air emboli. Two types of air embolism could be differentiated; the single-bubble type and the "stormy-bubble" type. The single-bubble type was observed during skin and muscle incisions, craniotomy, and brain lesion excision. Further embolism development was prevented by electrocoagulation and application of bone wax. The stormy-bubble type occurred during dura and muscle incisions and was prevented by electrocoagulation, reflection of the dura, or suturing the affected muscle. The routine use of a Swan-Ganz catheter for removal of air embolism by suction proved effective for the treatment of the stormy-bubble type of air embolism. Masking the operative field with saline-soaked cotton strips was of moderate benefit in the stabilization of the single-bubble type of air influx, but proved to be of little value in controlling the entrance of the stormy-bubble type.
使用实时二维超声心动图检测坐位神经外科手术患者是否存在空气栓塞。该技术能够以良好的敏感性在术中检测到单个气泡的出现，从而允许早期干预以防止进一步空气栓子的形成。可区分两种类型的空气栓塞：单泡型和“风暴泡”型。单泡型在皮肤和肌肉切开、开颅手术以及脑病变切除过程中观察到。通过电凝和应用骨蜡可防止进一步的栓塞形成。“风暴泡”型在硬脑膜和肌肉切开时出现，可通过电凝、硬脑膜翻转或缝合受影响的肌肉来预防。常规使用Swan-Ganz导管通过抽吸去除空气栓塞被证明对治疗“风暴泡”型空气栓塞有效。用盐水浸湿的棉条覆盖手术区域对稳定单泡型空气流入有一定益处，但在控制“风暴泡”型空气进入方面价值不大。
