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[中心静脉导管拔除后发生静脉空气栓塞:一例报告]

[Venous air embolism following removal of central venous catheters: A case report].

作者信息

Wan Li, Zhang Zhoucang, Ding Jiaxiang, Wang Mei

机构信息

Department of Nephrology, Peking University International Hospital, Beijing 102206, China.

Department of Nephrology, Peking University People' s Hospital, Beijing 100044, China.

出版信息

Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Oct 18;56(5):938-941. doi: 10.19723/j.issn.1671-167X.2024.05.030.

Abstract

Air embolism is a rare but dreaded complication of medical or surgical procedures with significant mortality. An abnormal air-to-blood pressure gradient and communication between the vein and atmosphere can lead to the venous air embolism. Here, we presented a rare case of venous air embolism just after the removal of the central venous catheters. A 59-year-old female was admitted to Peking University International Hospital suffering from neuromyelitis optica spectrum disorder. After 5 rounds of immunosorbent therapy, her hemodialysis catheter was removed. Five hours later, she suddenly experienced shortness of breath, dizziness, weakness of the lower extremities, transient loss of consciousness and seizures. Ultrasound showed a small amount of gas in the right internal jugular vein and brain CT showed scattered air accumulation in part of venous blood ducts and bilateral cavernous sinuses, which was diagnosed as air embolism. High-flow oxygen inhalation, compression of the right neck extubation site, head down and feet up left decubitus position, intravenous fluid therapy were used. The patient gradually improved and returned to normal activities after one week. To sum up, air embolism is a rare, but serious and life-threatening complication after central catheters removal. Clinicians need to be alerted and take appropriate preventive measures.

摘要

空气栓塞是医疗或外科手术中一种罕见但可怕的并发症,死亡率很高。异常的气-血压力梯度以及静脉与大气之间的连通可导致静脉空气栓塞。在此,我们报告了一例拔除中心静脉导管后即刻发生静脉空气栓塞的罕见病例。一名59岁女性因视神经脊髓炎谱系障碍入住北京大学国际医院。经过5轮免疫吸附治疗后,拔除了她的血液透析导管。5小时后,她突然出现呼吸急促、头晕、下肢无力、短暂意识丧失和癫痫发作。超声显示右颈内静脉有少量气体,脑部CT显示部分静脉血管和双侧海绵窦有散在积气,诊断为空气栓塞。给予高流量吸氧、压迫右颈部拔管部位、头低脚高左侧卧位、静脉输液治疗。患者逐渐好转,一周后恢复正常活动。综上所述,空气栓塞是拔除中心导管后一种罕见但严重且危及生命的并发症。临床医生需要提高警惕并采取适当的预防措施。

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