内镜逆行胰胆管造影术(ERCP)是诊治肝胆胰疾病的关键内镜技术。ERCP并发空气栓塞罕见，但具有致死、致残性高以及识别困难等特点，目前对其机制、临床表现及紧急应对策略仍存在不足。空气栓塞需要两个先决条件：开放的血管通路和异常的压力梯度。根据栓塞血管可分为静脉、动脉及反常空气栓塞。其临床表现多样且缺乏特异性，早期识别难度大，在镇静麻醉状态下易被掩盖，易导致延误诊断。主要危险因素包括胆道手术史、乳头括约肌切开、胆-静脉瘘形成、胆道支架植入等。诊断需综合术中生命体征监测、影像学检查以及循环、神经系统评估。治疗核心在于快速识别与干预，包括终止操作、100%氧气吸入、体位调整和保持血液动力学稳定。预防策略强调严格把握ERCP适应证、术前筛查高风险病人、使用CO₂替代空气注气以及加强术中实时监测等。临床医师需具备空气栓塞相关风险意识，通过优化操作流程、完善监测措施及制定应急预案，全面提升对这一危重并发症的防控能力。

Endoscopic retrograde cholangiopancreatography (ERCP) is a pivotal endoscopic technique for hepatobiliary and pancreatic diseases. Although rare, air embolism during ERCP carries a high risk of mortality and disability, with significant challenges in timely recognition. Current understanding of its pathogenesis, clinical manifestations, and emergency management remains insufficient. Air embolism requires two prerequisites: an open vascular pathway​and abnormal pressure gradients. It can be classified into venous, arterial, and paradoxical​subtypes based on the embolized vasculature. Clinical presentations are nonspecific and heterogeneous, often​masked by sedation or anesthesia, leading to delayed diagnosis. Key risk factors include prior biliary surgery, sphincterotomy, biliovenous fistula formation, and biliary stent placement. Diagnosis relies on integrating intraoperative vital sign monitoring, imaging​examination, and ​cardiocirculatory/neurological assessments. Timely recognition and intervention are critical, including​procedure termination, 100% oxygen therapy, positional adjustment, and hemodynamic stabilization. Preventive strategies involve strict adherence to ERCP indications, preoperative screening of high-risk patients, CO₂ insufflation ​instead of air, and ​enhanced intraoperative real-time monitoring. Clinicians should maintain a high alert for air embolism, optimize procedural protocols, implement surveillance, and establish emergency response plans ​to mitigate this life-threatening complication.