神经外科全麻坐位手术中静脉空气栓塞42例回顾性分析

Retrospective Analysis of 42 Cases of Venous Air Embolism During Neurosurgery in Sitting Position under General Anesthesia

[目的]回顾性分析本院神经外科坐位全身麻醉手术过程中静脉空气栓塞（VAE）的监测、发生、预防及处理.[方法]搜集本院神经外科2011年3月至2013年5月的215例坐位全身麻醉下行手术的患者的临床资料,以术中呼气末二氧化碳分压（PETCO2）出现急性地、持续性地、原因不明地下降≥5 mmHg为VAE的诊断标准.相关的数据从医疗记录资料中提取并分别予以比较,统计手术过程中VAE的监测、发生、预防及处理等情况.[结果]术中VAE总发生率为19.5％（42/215）,经积极的处理后,患者的各项生命体征恢复正常,术后均恢复自主呼吸并正常苏醒,无明显后遗症,也未出现VAE相关的致残或致死病例.[结论]在无更敏感监测手段下行神经外科坐位全身麻醉手术,PETCO2监测能够为有经验的麻醉医生对预防VAE的发生提供参考.

[Objective]To retrospectively analyze the monitoring,incidence,prevention and treatment of venous air embolism （VAE） during neurosurgery in sitting position under general anesthesia.[Methods]Clinical data of 215 patients undergoing the operation in sitting position under general anesthesia in neurosurgery department of our hospital from March 2011 to May 2013 were collected.The diagnostic criteria of VAE was defined as acute,persistent,cryptogenic decrease of partial pressure of carbon dioxide in end expiratory gas（PETCO2）（≥5mmHg） during the operation.The relevant data were extracted from medical records and compared respectively.The monitoring,incidence,prevention and treatment of VAE during the operation were analyzed.[Results] The total incidence of VAE during the operation was 19.5 ％ （42/215）.After active treatment,the vital signs of patients returned to normal level.All patients recovered spontaneous breath and normal waking status.No obvious sequela occurred.No VAE-relevant mutilation and death was found.[Conclusion]If there are no any more sensitive monitoring apparatuses,PETCO2 monitoring can provide the reference for the experienced anesthesiologists to prevent the incidence of VAE during the neurosurgery in sitting position under general anesthesia.