脑冠状动脉气体栓塞症患者短暂症状缓解后再次恶化：病例报告。
Secondary deterioration in a patient with cerebral and coronary arterial gas embolism after brief symptom resolution: a case report.
机构信息
Yokohama Municipal Citizen's Hospital 1-1, Mitsuzawanishi-chou, Kanagawa-ku, Yokohama-city, Kanagawa-ken 221-0855, Japan.
Corresponding author: Dr Ryota Tsushima, Yokohama Municipal Citizen's Hospital 1-1, Mitsuzawanishi-chou, Kanagawa-ku, Yokohama-city, Kanagawa-ken 221-0855, Japan,
出版信息
Diving Hyperb Med. 2024 Mar 31;54(1):61-64. doi: 10.28920/dhm54.1.61-64.
INTRODUCTION
Hyperbaric oxygen treatment (HBOT) is recommended for arterial gas embolism (AGE) with severe symptoms. However, once symptoms subside, there may be a dilemma to treat or not.
CASE PRESENTATION
A 71-year-old man was noted to have a mass shadow in his left lung, and a transbronchial biopsy was performed with sedation. Flumazenil was intravenously administered at the end of the procedure. However, the patient remained comatose and developed bradycardia, hypotension, and ST-segment elevation in lead II. Although the ST changes spontaneously resolved, the patient had prolonged disorientation. Whole- body computed tomography revealed several black rounded lucencies in the left ventricle and brain, confirming AGE. The patient received oxygen and remained supine. His neurological symptoms gradually improved but worsened again, necessitating HBOT. HBOT was performed seven times, after which neurological symptoms resolved almost completely.
CONCLUSIONS
AGE can secondarily deteriorate after symptoms have subsided. We recommend that HBOT be performed promptly once severe symptoms appear, even if they resolve spontaneously.
简介
高压氧治疗（HBOT）推荐用于有严重症状的动脉气体栓塞（AGE）。然而，一旦症状缓解，可能会出现治疗或不治疗的困境。
病例介绍
一名 71 岁男性被发现左肺有一个肿块阴影，并在镇静下进行了经支气管活检。在手术结束时静脉注射氟马西尼。然而，患者仍处于昏迷状态，并出现心动过缓、低血压和 II 导联 ST 段抬高。尽管 ST 改变自发缓解，但患者出现长时间定向障碍。全身计算机断层扫描显示左心室和大脑有几个黑色圆形透亮区，证实为 AGE。患者接受了氧气并保持仰卧位。他的神经症状逐渐改善，但再次恶化，需要 HBOT。进行了七次 HBOT，之后神经症状几乎完全缓解。
结论
AGE 可能在症状缓解后再次恶化。我们建议一旦出现严重症状，即使症状自发缓解，也应立即进行 HBOT。
Zotero 插件