上腔静脉逆行灌注救治体外循环期间动脉大量气栓(附7例报告)

Management of Massive Arterial Air Embolism During Cardiopulmonary Bypass-Report of 7 Cases

本文报告７例心脏直视手术体外循环期间动脉大量气栓，经上腔静脉逆行灌注等抢救，４例存活。随防１～６年，３例无永久性中枢神经系统损害。采用的逆灌压力４．０～８．０ｋＰａ，略高于以往文献报道。作者认为：上腔静脉逆行灌注能排除脑血管内气体，再经右心房逆行灌注可排除冠状血管内气体。这对解除或减轻中枢神经系统和心肌损伤、防止严重低心排综合征的发生、增加心脑复苏机会十分重要。应在气栓发生后即刻采用。高压氧可促进脑气栓吸收，增加脑组织氧供，改善脑损伤后遗症。应在病人循环功能稳定后及早进行。

Massive arterial air embolism occured in 7 patients undergoing open-heart operation during cardiopulmonary bypass(CPB).Retrograde perfusion through superior vena cava was performed immediately.The retrograde perfusion pressure reached 8.0kPa which was higher than the pressures used for same purpose by other authors reported in literatures.Four patients survived and were followed up for 1 to 6 years. No neurological sequelae occurred in 3 patients.The authors suggest that superior vena cava and right atrium retrograde perfusion can remove most air embolism in the blood vessels of the brain and heart to reduce/relief the injuries of them and prevent occurrence of serious low cardiac output.It is very important for the resuscitation the brain and heart,and should be used as soon as massive arterial air embolism occurs during CPB.Hyperbaric oxygenation can promote the absorbing of air embolism of the brain vessels,improve the oxygen supply of the brain tissues and improve neurological sequelae.It should be used as early as patient's circulatory function is steady.