孕婦於脊髓或硬腦膜外麻醉行剖腹產時產生靜脈空氣栓塞的發生率

Incidence of Venous Air Embolism in Parturients during Cesarean Section with Regional Anesthesia

呂學嘉(Hoga Lu) ； 江永源(Yung-Yuan Chiang) ； 林若絜(Zou-Chei Lin) ； 周志道(Chih-Dou Chou) ； 洪柏園(Po-Yuan Hong) ； 鄭榮耀(Rong-Yaw Cheng) ； 梁灝根(Ho-Kang Leung)

《Acta Anaesthesiologica Sinica》 29卷4期 (1991/12) Pp. 709-714

摘要

本研究目的是探討台灣孕婦行剖腹產時產生靜脈空氣栓塞及其併發症之情形，選取60位ASA體位分等第I－II級預備行剖腹產並施行半身麻醉的孕婦，以胸前Doppler心音來診斷及評估靜脈空氣栓塞的發生，同時觀察所產生之症狀及徵候的變化。結果發現Doppler心音有變化，即可能有靜脈空氣栓塞的發生率爲63.3%；且Doppler心音有變化與伴隨之症狀及徵候有很強的相關性，如：胸悶痛78.9%、呼吸不順暢60.5%及心跳變化86.8%。此外發現Doppler心音產生變化者以子宮切開（81.6%）和子宮縫合時（97.4%）最常見。雖然發生靜脈空氣栓塞與脊髓麻醉或硬腦膜外麻醉無關，唯與手術方法及病人的姿勢有關。另外，給予產婦氧氣可緩解因靜脈空氣栓塞所造成的症狀，因此剖腹產時以Doppler心音作監測可及早診斷靜脈空氣栓塞，以便早期治療。

關鍵字

靜脈空氣栓塞 ； 剖腹產 ； Echocardiography: Doppler ； Anesthesia: spinal and epidural

並列摘要

The purpose of the study is to probe the situation of venous air embolism (VAE) and the accompanying complications occurring in Chinese parturients in Taiwan during Cesarean section. Sixty ASA physical status class I-II parturients who were subjected to ceserean section under regional anesthesia were evaluated. The sensor of the Doppler device was placed on the anterior chest to detect the rumbles of air when it came to pass, and simultaneously the signs and symptoms following VAE were observed. Our results demonstrated that the usual or normal Doppler heart sound changed in 38 parturients out of 60 (63.3%), and the alteration occured very often when the uterus was being incised (81.6%), or sutured (97.4%), and concurred strong correlation with such signs and symptoms such as chest tightness or precordial pain (78.9%), shortness of breath (60.5%), and change of heart rate or blood pressure (86.8%). The method of anesthesia (spinal or epidural block) did not have effect on the occurrence of VAE, but different surgical approaches and different positions in which the patients were posed during operation did apparently bring about VAE of variable degree. Besides, supplying of oxygen could mitigate the symptoms produced by VAE. Consequently, the application of Doppler monitor during Cesarean section can detect VAE earlier and more efficiently and thus provides information timely treatment.