Tovar E A, Del Campo C, Borsari A, Webb R P, Dell J R, Weinstein P B
Division of Cardiovascular Surgery, St. Jude Medical Center, Fullerton, California, USA.
Ann Thorac Surg. 1995 Oct;60(4):1138-42. doi: 10.1016/0003-4975(95)00531-o.
Cerebral gaseous microemboli are present in most, if not all, cardiopulmonary bypass-assisted operations. Fortunately, the great majority are subclinical. Clinically significant cases of cerebral air embolism are largely underdiagnosed, undertreated, and underreported. The management of cerebral air embolism has been challenged due to the lack of prospective, randomized studies. Preventive measures that have been implemented throughout the years, resulting from empirically acquired knowledge, have avoided frequent major mishaps. Perfusion accidents, in which massive amounts of gas are pumped into patients, are managed intraoperatively by common-sense heroic measures which, at best, remove 50% of the embolized gas. Postoperative confirmation of a neurologic insult after a cardiopulmonary bypass-assisted operation, in which a cerebral air embolism is likely the source, is one of the most distressing situations a surgical team has to confront, due in part to the lack of pathognomonic diagnostic tools and to the absence of a "scientifically proven" (supported by prospective, randomized studies) therapeutic regimen. In lieu of the latter, we present the physical and physiologic bases that will justify the use of several therapeutic tools when facing a suspected CAE. These tools, when applied rationally, will represent some of the most innocuous modalities in the medical armamentarium.
在大多数（即便不是所有）体外循环辅助手术中都存在脑气体微栓子。幸运的是，绝大多数是亚临床的。具有临床意义的脑空气栓塞病例在很大程度上存在诊断不足、治疗不足和报告不足的情况。由于缺乏前瞻性、随机研究，脑空气栓塞的管理一直面临挑战。多年来基于经验积累的知识所实施的预防措施避免了频繁发生的重大事故。对于灌注事故，即大量气体被泵入患者体内的情况，术中通过常识性的大胆措施进行处理，这些措施充其量只能清除50%的栓塞气体。在体外循环辅助手术后，若怀疑脑空气栓塞是神经损伤的根源，术后对神经损伤的确认是手术团队必须面对的最令人苦恼的情况之一，部分原因是缺乏特异性诊断工具以及缺乏“科学验证”（由前瞻性、随机研究支持）的治疗方案。鉴于后者的缺失，我们阐述了在面对疑似脑空气栓塞时使用几种治疗工具的物理和生理依据。这些工具若合理应用，将是医疗手段中一些最无害的方式。
