Papadopoulos G, Kuhly P, Brock M, Rudolph K H, Link J, Eyrich K
Klinik für Anaesthesiologie und operative Intensivmedizin, Universitätsklinikum Steglitz, Freien Universität Berlin, Federal Republic of Germany.
Acta Neurochir (Wien). 1994;126(2-4):140-3. doi: 10.1007/BF01476424.
This prospective study investigates the frequency of patent foramen ovale (PFO), venous air embolism (VAE) and paradoxical air embolism (PAE) by transoesophageal echocardiography (TOE) in neurosurgical patients operated on in the sitting position. The risk of PAE after exclusion of PFO is assessed. A PFO was identified by pre-operative TOE and VAE and PAE by continuous intraoperative TOE. Sixty-two patients were divided into two groups, 22 patients were studied in group 1 (posterior fossa surgery) and group 2 (cervical surgery) contained 40 patients. Pre-operative TOE demonstrated a PFO in 5 of the 22 patients in group 1 (23%). Patients with proven PFO were excluded from the sitting position. Two further patients of this group (12% of 17 patients), in whom a PFO had been excluded pre-operatively, nevertheless had PAE, air occurring in all cavities of the heart. In group 2 the incidence of PFO was 4 out of 40 patients (10%). No PAE was observed in this group. Three morphological types of VAE with different haemodynamic and ventilation changes were demonstrated. VAE was observed in 76% of all posterior fossa operations and in 25% of cervical laminectomies. We conclude that a pre-operative search for PFO is mandatory considering its incidence of 23% in group 1 and of 10% in group 2, and the risk of PAE. If a PFO is detected, the sitting position should be avoided. A residual risk for PAE remains despite exclusion of PFO because the reliability of TOE is limited. TOE is the method of choice for detecting VAE and PAE.
这项前瞻性研究通过经食管超声心动图（TOE）调查了坐位接受神经外科手术患者的卵圆孔未闭（PFO）、静脉空气栓塞（VAE）和反常空气栓塞（PAE）的发生率。评估了排除PFO后发生PAE的风险。术前通过TOE识别PFO，术中通过连续的TOE监测VAE和PAE。62例患者分为两组，第1组（后颅窝手术）22例患者，第2组（颈椎手术）40例患者。术前TOE显示，第1组22例患者中有5例（23%）存在PFO。证实有PFO的患者不采用坐位手术。该组另有2例患者（17例患者中的12%），术前已排除PFO，但仍发生了PAE，心脏各腔均出现空气。第2组中，40例患者中有4例（10%）存在PFO。该组未观察到PAE。显示了三种具有不同血流动力学和通气变化的VAE形态类型。所有后颅窝手术中有76%观察到VAE，颈椎椎板切除术中25%观察到VAE。我们得出结论，鉴于PFO在第1组中的发生率为23%，在第2组中的发生率为10%，以及PAE的风险，术前筛查PFO是必要的。如果检测到PFO，应避免采用坐位。尽管排除了PFO，但PAE仍存在残余风险，因为TOE的可靠性有限。TOE是检测VAE和PAE的首选方法。
