Frim D M, Wollman L, Evans A B, Ojemann R G
Neurosurgery Service, Massachusetts General Hospital, Boston, USA.
J Neurosurg. 1996 Nov;85(5):937-40. doi: 10.3171/jns.1996.85.5.0937.
Acute pulmonary edema after a large air embolus occurring during neurosurgery is a recognized phenomenon. The authors describe the course of a 76-year-old man who presented with noncardiogenic pulmonary edema shortly after undergoing resection of a high convexity meningioma. Transthoracic Doppler sonography, however, showed no evidence of a large intraoperative emboli; the evidence for ongoing but low-magnitude air embolus included visualization of bone aspiration of irrigant before bone-edge waxing, transient intraoperative declines in end-tidal CO2 tension, and an increase of the fraction of inspired oxygen to maintain adequate saturation after removal of the craniotomy flap. There was no hemodynamic instability noted. The airspace disease was self-limited and resolved on supportive treatment after approximately 1 week, as would be expected for pulmonary edema caused by a single large intravenous air embolus. The authors present this case as the first report of pulmonary edema resulting from low-level air embolus occurring during craniotomy. This situation may go unrecognized intraoperatively but can cause the same significant postoperative morbidity as larger, more easily identified air emboli.
神经外科手术期间发生大量空气栓塞后出现急性肺水肿是一种公认的现象。作者描述了一名76岁男性的病程，该患者在接受高凸脑膜瘤切除术后不久出现非心源性肺水肿。然而，经胸多普勒超声检查未发现术中存在大量栓子的证据；存在持续但程度较轻的空气栓塞的证据包括在骨缘涂蜡前可见冲洗液的骨抽吸现象、术中呼气末二氧化碳分压短暂下降，以及在移除开颅皮瓣后为维持足够的血氧饱和度而增加吸入氧分数。未观察到血流动力学不稳定情况。气腔疾病为自限性，在大约1周的支持治疗后得到缓解，这与单个大量静脉空气栓塞所致肺水肿的预期情况相符。作者将此病例作为开颅手术期间发生的低水平空气栓塞导致肺水肿的首例报告。这种情况在术中可能未被识别，但可导致与更大、更易识别的空气栓塞相同严重的术后发病率。
