CT引导下经皮肺穿刺活检并发体循环空气栓塞的危险因素

Risk factors of complicated systemic circulation air embolism in CT-guided percutaneous lung biopsy

目的探讨经皮肺穿刺并发体循环空气栓塞的危险因素。方法回顾性分析1 121例经皮肺穿刺活检患者的资料,根据穿刺过程中及穿刺结束后胸部CT观察是否伴发体循环空气栓塞,将其分为并发体循环空气栓塞组(气栓组)与无体循环空气栓塞组(对照组)。以两独立样本t检验或Fisher确切概率法比较2组间患者因素(年龄、性别、是否咳嗽、是否有肺气肿)、病灶因素[病灶最大径、位置(上、中叶或下叶)、深度(穿刺方向胸膜到病灶边缘的距离)、病灶性质(实性、部分实性)]、穿刺过程因素[穿刺时病灶实际位置是否高于左心房水平、穿刺体位、是否应用套管针、取样次数、手术时间(开始进行病灶定位扫描到手术完成后复查CT结束的时间)、术后是否有气胸和周围肺野出血]的差异。结果 12例(12/1 121,1.07%)发生体循环空气栓塞,其中11例(11/12,91.67%)于左心室检出气体,仅2例出现明显症状。穿刺时病灶实际位置是否高于左心房位置及穿刺过程中是否咳嗽组间差异有统计学意义(P=0.02、0.04)。结论穿刺时病灶实际位置高于左心房位置及穿刺过程中咳嗽可能是CT引导下经皮肺穿刺活检并发体循环空气栓塞的危险因素。

Objective To explore the risk factors of complicated systemic circulation air embolism in CT-guided percutaneous lung biopsy.Methods Totally 1 121 patients underwent CT-guided percutaneous lung biopsy were retrospectively analyzed,and were divided into concurrent air embolism group(test group)and no air embolism complications group(control group)according to whether air embolization occurred or not during the operations.For patient factors(age,gender,cough and emphysema),lesion factors(maximum diameter of lesion,location[upper,middle or lower lobe],depth[distance between the pleura in puncture direction to the edge of lesion]and nature of lesion[solid,partially solid]),puncture process factors(whether actual location of lesion during puncture was higher than that of the level of the left atrium,puncture position,whether the trocar was applied,the number of samples,the operation time[time of starting the positioning scan of the lesion to the completion of the operation and review the time of the end of CT],postoperative pneumothorax and peripheral lung bleeding)were analyzed with t test or Fisher's exact test.Results Twelve patients(12/1 121,1.07%)were detected with air embolism.The left ventricular was frequently evolved(11/12,91.67%),while obvious symptoms were observed in only 2 patients.The differences of whether the actual location of lesion was higher than that of the left atrium during puncture and whether coughing during puncture between the two groups were statistically significant(P=0.02,0.04).Conclusion The actual location of lesion during puncture is higher than that of the left atrium and coughing during puncture may be risk factors for systemic circulation air embolism in CT-guided percutaneous lung biopsy.