A Case Report And Literatures Review Of Cerebral Air Embolism Related To The Operation Of Intervention Pulmonary

Objective:To investigate the causes,epidemiology,pathogenesis,clinicalmanifestations,diagnosis,treatment and prevention of cerebral embolism caused by intervention pulmonary and to increased awareness of this rare and fatal complication.Methods: We report a case of cerebral arterial embolism triggered by building insaiable pneumothorax before medical thoracoscopy in2016 in the Affiliated Hospital of Southwest Medical University,and relevant literatures were reviewed.We tracked and searched the correlative references and study reports about cerebral arterial embolism in Wanfang database?CNKI?VIP database network China and Pubmed database.Deadline is August2016.Results: The case was a 68 year old female,Cough with dyspnea 1 months as the chief complaint was admitted to hospital in July 16,2016.Chest CT showed that left side pleural thickening,pleural effusion,pleural mesothelioma?metastatic tumor? combined the correlation examination,the left lung atelectasis,partial atelectasis of the lung tissue is uneven;mediastinum right avertence,the majority of lymph nodes of mediastinum showed.Right upper and middle lung at electasis,scattered in inflammation in the ri ght lung? Ri ght pleural thickening;multiple calcification of the left coronary artery and arcus aortae;degeneration of vertebra thoracalis;right kidney stones? Cytology of lymph node puncture in the left supraclavicular fossa(pathological number 2017788)and cell mass(pathological number 2019610)showed metastatic lymph node adenocarcinoma.We arranged thoracic close drainage,pleural effussion receivedthe clinical application of acid-fast bacillus and exfoliated cells,the exfoliated cells showed that the majority of neutrophile granulocyte(NO.2012190;NO.2017544).To search for primary lesions,the patient received medical thoracoscopy,informed consent forms signed and completion of preoperative preparation,builded insaiable pneumothorax before medical thoracoscopy.To the left side of the pleural cavity slowly injected air about 300 ml,gas injection process,the patient had not special symptom,arranged a stretcher to send patient to receive the chest CT after surgery.She was found to have bilaterally dilated pupils.Informed consent forms signed,a head computed tomography(2016-7-20,NO.1510759)scan demonstrated diffuse air embolism with pneumocephalus.We informed the patient or their family to choose the follow-up therapy,released therapy and leaved hospital.One month later,the patient was followed up by telephone.The patient's consciousness was clear,but there was still a right limb dysfunction.In the database,total of 25 aticles of which included 6 Chinese literatures and 19 English literatures.A total of 35 cases of cerebral air embolism related to intervention pulmonary,included 34 cases in the literatures.5 cases were not described gender and age,16 males and 14 females,aged from 40 to 89 years old.Accepted operation:17 cases of CT-guided percutaneous lung biopsy for diagnosis and treatment of lung disease,11 cases of fiberoptic bronchoscopy procedure included 6 cases of TBLB,1 case of TBNA,3 cases of bronchoscopic Nd: YAG laser interventional technology,1 case of bronchoscopic argon plasma coagulation,5 cases of insaiable pneumothorax before medical thorascopy,flushing cavity with aquae hydrogenii dioxide.The main symptoms were 20 cases of unconsciousness,12 cases were hemiplegia:7 cases of right hemiplegia,4 cases of left hemiplegia,1 case of diplegia,8 cases of limb twitch,2 casesof acroanesthesia,1 cases of blindness,2 cases of pupilary light reflex was absent,3 cases of respiratory and cardiac arrest.Iconography:4 cases were not described,1 case of Chest X-ray showed pneumothorax,6 cases accepted Chest CT:1 case of pneumothorax,6 cases of ventriculus sinister air embolism.Treatments:25 cases of hyperbaric oxygenation,5 cases of oxygen inhalation,25 cases of nourishing brain cells,2 cases of cardio-pulmonary resuscitation,5 cases required mechanical ventilation.Outcome:19cases were cured,8 cases with deformity,7 cases were died.Conclusions:1.Cerebral arterial embolism is a fatal and rare complication with intervention pulmonary,we should be realized and paid attention to it.2.Cerebral arterial embolism mainly showed transient or permanent dysfunction of the central nervous system,small amount of air mainly featured severe symptoms and even death.3.Cerebral arterial embolism is a fatal and rare complication,hyperbaric oxygenation should be a first-line approach.4.Not only constant vigilance and prevention is necessry in order to avoid the complication of cerebral arterial embolism,but also first aid is the most important thing.