於肝臟移植手術中因空氣栓塞引發心室顫動的成功處置經驗

Successful Management of Air Embolism-Induced Ventricular Fibrillation in Orthotopic Liver Transplantation

心室顫動在非心臟手術中雖然不常發生，卻伴隨著很高的死亡率。在此我們報告一病例，在肝藏移植手術中，於剝離門脈側支血管，疑似因空氣栓塞而引發心室顫動。經過適當的急救處置，以及開胸心臟按摩後，病患的預後狀況非常良好。經食道心臟超音波是診斷靜脈氣栓的有力工具，在肝硬化的病人身上雖非絕對禁忌症，但須謹慎使用，以免引發食道靜脈出血。在本肝藏移植病例中，於剝離門脈側支血管時，因形成空氣栓塞而引發心室顫動。本文將提出我們急救的成功經驗，及回顧相關的文獻。

Ventricular fibrillation (VF) although less common during noncardiac surgery often brings about severe compli-cation as an aftermath. We report a case of VF which was highly suspected to be induced by air embolism at the moment when the surgeon was dissecting the collateral vessels of portal vein in liver transplantation surgery. The outcome of this patient was excellent due to aggressive resuscitative measures including open-chest cardiac massage. Transesophageal echocardiogram (TEE) was not applied in this patient in fear of increased risk of esophageal varicose bleeding in a liver cirrhotic patient. However, some reports described the use of TEE in cirrhotic patients without obvious complications. In this case, venous air embolism (VAE) happened during the dissection of collateral vessels of the portal vein, which to our knowledge was ever been reported in liver transplantation surgery. The related literature has been reviewed and the success of the resuscitation is also herein discussed.