ct引导下经胸介入手术后的空气栓塞：是否需要改变患者体位以防止栓塞的空气进入体循环？

IF 3.4 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

British Journal of Radiology Pub Date : 2025-04-10 DOI:10.1093/bjr/tqaf078

Ran Yan, Zeng-Jian Yang, Zhen-Guo Huang, Hong-Liang Sun, Yan-Yan Xu, Yu-Li Wang, Bao-Xiang Gao, Chuan-Dong Li, Shi-Long Sun, Tong-Yin Zhang, Hao-Yu Li, Yu-Wan Hu

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引用次数: 0

摘要

目的：探讨空气栓塞（AE）后患者体位对栓塞空气进入体循环的影响。材料与方法：选取116例AE患者作为研究对象，其中影像学胸腔镜手术前行ct引导下经胸活检81例，ct引导下肺结节定位35例。116例患者中有94例在AE后5 ~ 15分钟内至少进行了一次随访CT。以下两种情况考虑栓塞空气进入体循环：(1)CT显示主动脉和/或分支有空气；(2)随访CT示左心空气减少或消失。结果：116例AE患者的体位包括仰卧位（SP） 6例，俯卧位（PP） 70例，左侧卧位（LLDP） 20例，右侧卧位（RLDP） 20例。SP患者中有33.3%（2/6）、PP患者中有47.1%（33/70）、LLDP患者中有70%（14/20）、RLDP患者中有55%（11/20）出现栓塞性空气进入体循环。差异无统计学意义（χ2=4.16, p = 0.24）。结论：急性脑损伤后5 ~ 15分钟内，SP、PP、LLDP、RLDP患者栓塞空气进入体循环的比例相似。以上四个位置都不能有效阻止被栓塞的空气进入体循环。知识进展：大约一半的AE患者被栓塞的空气在几分钟内进入体循环。AE后5 ~ 15分钟内，SP、PP、LLDP、RLDP患者的栓塞空气进入体循环的比例相似。AE后改变患者体位并不能阻止栓塞空气进入体循环。

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Air embolism after CT-guided transthoracic interventional operation: Is it necessary to change the patient's position to prevent embolized air from entering the systemic circulation.

Objectives: To investigate the influence of the patient's position on the entry of embolized air into the systemic circulation after air embolism (AE).

Materials and methods: 116 patients with AE were selected as study subjects, including 81 patients undergoing CT-guided transthoracic biopsy and 35 patients undergoing CT-guided localization of pulmonary nodule before video-assisted thoracoscopic surgery. While maintaining the patient's original position, 94 out of 116 patients underwent at least one follow-up CT within 5 to 15 minutes after AE. The following two situations were considered as embolized air entering into systemic circulation: (1) CT showed air in the aorta and/or branches; (2) Follow-up CT showed a decrease or disappearance of air in the left heart.

Results: The positions of the 116 patients with AE included 6 in supine position (SP), 70 in prone position (PP), 20 in left lateral decubitus position (LLDP) and 20 in right lateral decubitus position (RLDP). Embolized air entering the systemic circulation occurred in 33.3% (2/6) patients in SP, 47.1% (33/70) patients in PP, 70% (14/20) patients in LLDP, and 55% (11/20) patients in RLDP. The difference is not statistically significant (χ2=4.16, p = 0.24).

Conclusions: The proportion of embolized air entering the systemic circulation is similar among patients in SP, PP, LLDP and RLDP within 5-15 minutes after AE. The above four positions can not effectively prevent the embolized air from entering the systemic circulation.

Advances in knowledge: Embolized air enters the systemic circulation within a few minutes in about half of patients with AE. Within 5-15 minutes after AE, the proportion of embolized air entering the systemic circulation is similar among patients in SP, PP, LLDP, and RLDP. Changing the patient's position after AE can not prevent embolized air from entering the systemic circulation.

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来源期刊

British Journal of Radiology 医学-核医学

CiteScore

5.30

自引率

3.80%

发文量

330

审稿时长

2-4 weeks

期刊介绍： BJR is the international research journal of the British Institute of Radiology and is the oldest scientific journal in the field of radiology and related sciences. Dating back to 1896, BJR’s history is radiology’s history, and the journal has featured some landmark papers such as the first description of Computed Tomography "Computerized transverse axial tomography" by Godfrey Hounsfield in 1973. A valuable historical resource, the complete BJR archive has been digitized from 1896. Quick Facts: - 2015 Impact Factor – 1.840 - Receipt to first decision – average of 6 weeks - Acceptance to online publication – average of 3 weeks - ISSN: 0007-1285 - eISSN: 1748-880X Open Access option