Kashuk J L, Penn I
Surg Gynecol Obstet. 1984 Sep;159(3):249-52.
Air embolism--the most dangerous complication of central venous catheterization--may occur in several ways. The most frequent is from disconnection of the catheter from the related intravenous tubing. An embolism may present with a sucking sound, tachypnea, air hunger, wheezing, hypotension and a "mill wheel" murmur. A later manifestation is severe pulmonary edema. In a review of 24 patients, the mortality was 50 per cent. Among the survivors, five (42 per cent) had neurologic damage. Immediate treatment includes placing the patient in the left lateral and Trendelenberg positions, administration of oxygen and aspiration of air from the heart. Cardiac massage and emergency cardiopulmonary bypass may be necessary. Most instances can be prevented by inserting the cannula with the patient in the Trendelenberg position, occluding the cannula hub except briefly while the catheter is inserted, fixation of the catheter hub to its connections and occlusive dressing over the track after removal of the catheter.
空气栓塞——中心静脉置管最危险的并发症——可能以多种方式发生。最常见的是导管与相关静脉输液管断开连接。空气栓塞可能表现为吸吮声、呼吸急促、气促、喘息、低血压和“水车样”杂音。较晚出现的表现是严重肺水肿。在对24例患者的回顾中，死亡率为50%。在幸存者中，5例（42%）有神经损伤。立即治疗包括将患者置于左侧卧位和头低脚高位、给予氧气以及从心脏抽出空气。可能需要进行心脏按摩和紧急体外循环。大多数情况可以通过在患者处于头低脚高位时插入套管、在插入导管时短暂除外均封堵套管接头、将导管接头固定至其连接处以及在拔除导管后对穿刺路径进行封闭敷料来预防。
