中心静脈カテーテル抜去後に両側海綿静脈洞の空気塞栓症を来した1例

Retrograde Cavernous Sinus Air Embolism after Central Venous Catheter Removal

Ⅰ．はじめに

　中心および末梢静脈カテーテルの挿入や抜去に伴い空気塞栓症を来すことがあるが，これは肺塞栓症や心腔内塞栓症，脳塞栓症など致死的な転帰となり得る重要な合併症である．今回われわれは，右内頚静脈経由で留置された中心静脈カテーテルの抜去後に海綿静脈洞内の空気塞栓症を生じ，一過性の意識障害を呈した症例を経験したので報告する．

　Air embolism is a rare, but occasionally fatal complication of peripheral and central venous catheterization. We present a case of an 89-year-old female, who had a central venous catheter placed in her right jugular vein during the perioperative period for right femoral subtrochanteric fracture. On the day following her operation, level of consciousness worsened a few minutes after the catheter was removed. CT scan showed air bubbles in bilateral cavernous sinuses and brachiocephalic vein. Administration of 100% oxygen was started, and she regained consciousness a few hours later, finally air bubbles disappeared on a CT scan performed 10 hours after onset. Air embolism should be taken into consideration when treating venous catheters, and appropriate O₂ administration and radiological examinations must be performed immediately if level of consciousness or vital signs deteriorate.