PDF(Pubmed)
Abstract：
BACKGROUND: Gas embolism is a rare but fatal clinical emergency. Hydrogen peroxide (H2O2) can cause gas embolism when improperly used in closed cavities or for deep and large wound irrigation.
METHODS: A 31-year-old woman was diagnosed with lumbar-3 tuberculosis and paravertebral abscess and underwent emergency spinal surgery in a prone position. After removing the tuberculous pus, 200 mL of H2O2 (3 % v/w) was used to repeatedly irrigate the abscess cavity. Immediately after irrigation, the patient suffered cardiac arrest. During cardiopulmonary resuscitation, transesophageal echocardiography revealed that the right cardiac cavity was filled with a diffuse \"Snowflake-Like\" gas embolus, and cranial computed tomography showed a multi-point pneumocephalus in the frontal lobes. The patient eventually suffered brain death despite the return of spontaneous circulation after active resuscitation.
CONCLUSIONS: H2O2 can quickly release abundant oxygen and water upon contact with catalase. Oxygen bubbles enter the vascular lumen and cause mechanical obstruction of the right cardiac circulation. In addition, H2O2 and oxygen bubbles may migrate upwards and enter the intracranial tissue through the epidural space or subdural space, resulting in intracranial pneumatosis. Diagnosis and treatment of gas embolism are extremely difficult. Some suggestions are that H2O2 should not be used in closed cavities or on deep and large wounds due to the potential risk of fatal gas embolism.
CONCLUSIONS: The fatal complications of gas embolism and pneumocephalus rarely occur simultaneously in one patient, and we aim to highlight this potential risk of intraoperative H2O2 use in spinal surgery.
METHODS: A 31-year-old woman was diagnosed with lumbar-3 tuberculosis and paravertebral abscess and underwent emergency spinal surgery in a prone position. After removing the tuberculous pus, 200 mL of H2O2 (3 % v/w) was used to repeatedly irrigate the abscess cavity. Immediately after irrigation, the patient suffered cardiac arrest. During cardiopulmonary resuscitation, transesophageal echocardiography revealed that the right cardiac cavity was filled with a diffuse \"Snowflake-Like\" gas embolus, and cranial computed tomography showed a multi-point pneumocephalus in the frontal lobes. The patient eventually suffered brain death despite the return of spontaneous circulation after active resuscitation.
CONCLUSIONS: H2O2 can quickly release abundant oxygen and water upon contact with catalase. Oxygen bubbles enter the vascular lumen and cause mechanical obstruction of the right cardiac circulation. In addition, H2O2 and oxygen bubbles may migrate upwards and enter the intracranial tissue through the epidural space or subdural space, resulting in intracranial pneumatosis. Diagnosis and treatment of gas embolism are extremely difficult. Some suggestions are that H2O2 should not be used in closed cavities or on deep and large wounds due to the potential risk of fatal gas embolism.
CONCLUSIONS: The fatal complications of gas embolism and pneumocephalus rarely occur simultaneously in one patient, and we aim to highlight this potential risk of intraoperative H2O2 use in spinal surgery.
摘要：
背景：气体栓塞是一种罕见但致命的临床急症。过氧化氢（H2O2）如果在封闭的空腔中使用不当或用于深大伤口冲洗，会导致气体栓塞。
方法：一名31岁女性被诊断为腰椎-3结核和椎旁脓肿，并在俯卧位接受了紧急脊柱手术。去除结核性脓液后，使用200mL的H2O2（3％v/w）反复冲洗脓肿腔。灌溉后，病人心脏骤停。心肺复苏期间,经食道超声心动图显示右心腔充满弥漫性“雪花样”气体栓子，和头颅计算机断层扫描显示额叶有多点气颅。尽管主动复苏后恢复了自发循环，但患者最终还是脑死亡。
结论：H2O2与过氧化氢酶接触后可迅速释放丰富的氧气和水。氧气泡进入血管腔并引起右心循环的机械阻塞。此外,H2O2和氧气气泡可能向上迁移并通过硬膜外腔或硬膜下腔进入颅内组织，导致颅内积气.气体栓塞的诊断和治疗极其困难。一些建议是，由于致命的气体栓塞的潜在风险，H2O2不应在封闭的腔中或深而大的伤口上使用。
结论：气体栓塞和气颅的致命并发症很少同时发生在一名患者中，我们的目标是强调脊柱手术术中使用H2O2的潜在风险.
方法：一名31岁女性被诊断为腰椎-3结核和椎旁脓肿，并在俯卧位接受了紧急脊柱手术。去除结核性脓液后，使用200mL的H2O2（3％v/w）反复冲洗脓肿腔。灌溉后，病人心脏骤停。心肺复苏期间,经食道超声心动图显示右心腔充满弥漫性“雪花样”气体栓子，和头颅计算机断层扫描显示额叶有多点气颅。尽管主动复苏后恢复了自发循环，但患者最终还是脑死亡。
结论：H2O2与过氧化氢酶接触后可迅速释放丰富的氧气和水。氧气泡进入血管腔并引起右心循环的机械阻塞。此外,H2O2和氧气气泡可能向上迁移并通过硬膜外腔或硬膜下腔进入颅内组织，导致颅内积气.气体栓塞的诊断和治疗极其困难。一些建议是，由于致命的气体栓塞的潜在风险，H2O2不应在封闭的腔中或深而大的伤口上使用。
结论：气体栓塞和气颅的致命并发症很少同时发生在一名患者中，我们的目标是强调脊柱手术术中使用H2O2的潜在风险.
