Taniguchi S, Irita K, Sakaguchi Y, Inaba S, Inoue H, Mishima H, Takahashi S
Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Tohoku J Exp Med. 1997 Dec;183(4):263-71. doi: 10.1620/tjem.183.263.
Because pulmonary embolism is often silent, simple clinical procedures are desirable to identify patients with a low to intermediate probability of pulmonary embolism. Among 19,467 patients managed under general anesthesia, we had one bile tract surgery case and three neurosurgical cases whose silent pulmonary embolism was initially suggested by an increase in the arterial to end-tidal CO2 gradient (from 17 to 27 mmHg) after general anesthesia was induced or their trachea was intubated. During the preoperative assessment, the patients presented no clinical manifestations suggestive of pulmonary embolism. Our initial diagnosis was confirmed by scintigraphy and/or angiography done immediately after the operations. Because capnometry has been shown to be applicable to non-intubated, spontaneously breathing patients, we suggest that measuring the gradient may serve as an additional method for unmasking silent pulmonary embolism in patients at risk or with disturbed consciousness, whether they are scheduled for operations or not.
由于肺栓塞通常没有症状，因此希望通过简单的临床程序来识别肺栓塞可能性较低至中等的患者。在19467例接受全身麻醉的患者中，我们有1例胆道手术病例和3例神经外科手术病例，其无症状肺栓塞最初是在全身麻醉诱导或气管插管后，通过动脉血二氧化碳分压与呼气末二氧化碳分压梯度增加（从17 mmHg增至27 mmHg）提示的。在术前评估期间，这些患者没有提示肺栓塞的临床表现。我们的初步诊断在术后立即进行的闪烁扫描和/或血管造影检查中得到证实。由于已证明二氧化碳监测适用于未插管的自主呼吸患者，我们建议测量该梯度可作为一种额外的方法，用于发现有风险或意识障碍的患者（无论是否计划进行手术）中的无症状肺栓塞。
