空气栓塞的特征是气泡进入循环系统,这可能导致血管阻塞,有可能危及生命.虽然通常与肺外伤或减压病有关,它也可以由医疗程序,如中心静脉导管插入或,在我们的案例中,腹腔镜手术的注气。我们介绍了一名65岁女性的病例,该女性在接受腹腔镜Nissen胃底折叠术后因空气栓塞继发中风,其中利用了腹腔的二氧化碳吹入。我们还将讨论这种并发症的病因和诊断,治疗,并提出了预防措施。一名65岁的女性,患有胃食管反流病和食管裂孔疝,选择接受腹腔镜尼森胃底折叠术进行疝修补术。手术成功后,患者被发现有明显的神经功能缺损,包括左侧偏瘫,左手麻木,偏盲,构音障碍,美国国立卫生研究院卒中量表得分为20分。CT头颅成像显示右额叶有几个低密度病灶,而CT颈部和胸部成像显示皮下气肿和纵隔气肿。随后的实验室对7.6mmol/L的乳酸升高具有重要意义。脑部MRI通过弥散加权成像(DWI)序列描绘了右额叶急性梗塞的证据。将影像学结果与患者的临床表现相关联,以建立非优势性半球卒中的诊断,位于右大脑中动脉(MCA)的前分支。插管和支持治疗三天后,患者拔管,能够听从指挥,但左上肢和下肢出现面部无力和力量减弱.在为期两个月的后续访问中,患者不再有任何局灶性神经功能缺损.空气栓子,虽然非常罕见,在利用CO2进行体腔吹气的腹腔镜手术中,可能会发生并发症。患者可能是无症状的小,自限性栓子,而其他人可能表现出肺部症状,心脏骤停,或局灶性神经系统变化,取决于表情符号的大小和位置。鉴于广泛的患者介绍,腹腔镜手术并发空气栓塞的死亡率升高,以及罕见的局灶性神经症状,快速诊断和密切的术后观察和治疗对于短期和长期患者的预后至关重要.
An air embolism is characterized by the entry of gas bubbles into the circulatory system, which can lead to the possible occlusion of blood vessels, posing a potentially life-threatening risk. While commonly associated with lung trauma or decompression sickness, it can also result from medical procedures such as central venous catheter insertion or, in our case, gas insufflation for laparoscopic surgery. We present the case of a 65-year-old female who suffered from a stroke secondary to an air embolism after undergoing a laparoscopic Nissen fundoplication in which carbon dioxide insufflation of the abdominal cavity was utilized. We also will discuss the elusive etiology of this complication as well as diagnosis, treatment, and proposed preventative measures. A 65-year-old female with gastroesophageal reflux disease and a hiatal hernia elected to undergo a laparoscopic Nissen fundoplication for hernia repair. After a successful surgery, the patient was found with significant neurological deficits, including left-sided hemiplegia, numbness in the left hand, hemianopsia, dysarthria, and a National Institutes of Health Stroke Scale score of 20. CT head imaging revealed several low-density foci in the right frontal lobe, while CT neck and chest imaging revealed subcutaneous emphysema and pneumomediastinum. Subsequent labs were significant for an elevated lactate at 7.6 mmol/L. MRI of the brain depicted evidence of an acute infarct in the right frontal lobe with diffusion-weighted imaging (DWI) sequences. The imaging results were correlated with the patient\'s clinical presentation to establish the diagnosis of a nondominant hemisphere stroke, localized to an anterior branch of the right middle cerebral artery (MCA). After intubation and supportive treatment for three days, the patient was extubated and able to follow commands but had left facial weakness and diminished strength in the left upper and lower extremities. At the two-month follow-up visit, the patient no longer had any focal neurological deficits. Air emboli, though very rare, can occur as a complication in laparoscopic surgeries that utilize CO2 for body cavity insufflation. Patients may be asymptomatic with small, self-limiting emboli, while others may exhibit pulmonary symptoms, cardiac arrest, or focal neurologic changes, depending on the emoji\'s size and location. Given the wide range of patient presentations, the elevated mortality of laparoscopic procedures complicated by air emboli, and the rare occurrence of focal neurological symptoms as depicted in this case, rapid diagnosis and close postoperative observation and treatment are vital for both short-term and long-term patient outcomes.