Ségura P, Kleinhans E, Schmitt A, Dosch J C, Tulasne P A
Service d'anesthésie et de réanimation, centre d'orthopédie et de traumatologie, France.
Ann Fr Anesth Reanim. 1998;17(7):728-34. doi: 10.1016/s0750-7658(98)80110-x.
We report a case of gas embolism into both right and left circulation in a polytrauma patient with lung contusions, revealed by thoracic CT scan showing the heart and aorta filled with gas. It followed a lung inflation with a O2/N2O mixture for about 30 seconds at a pressure of at least 40 cmH2O in order to obtain apnoea for CT scan and to recruit atelectatic territories. The presumed mechanism was the passage of the O2/N2O mixture during the lung inflation manoeuvre out of disrupted airways into torn pulmonary blood vessels and pushed back into the heart chambers. The patient recovered fully. Lung inflation manoeuvre to obtain a prolonged apnoea during CT scan examinations of thorax is contraindicated in case of thorax trauma, as it carries a risk of gas embolism.
我们报告一例多发伤合并肺挫伤患者发生气体同时栓塞至左右循环系统的病例，胸部CT扫描显示心脏和主动脉内充满气体。该情况发生在为进行CT扫描而用氧气/一氧化二氮混合气体在至少40 cmH₂O的压力下使肺膨胀约30秒以实现呼吸暂停并复张肺不张区域之后。推测的机制是在肺膨胀操作过程中，氧气/一氧化二氮混合气体从破裂的气道进入撕裂的肺血管，然后被推回心腔。患者完全康复。在胸部创伤的情况下，禁忌在胸部CT扫描检查期间进行肺膨胀操作以实现长时间呼吸暂停，因为这有气体栓塞的风险。
