Excessive Dynamic Airway Collapse-A Case Report

過度動態性呼吸道塌陷－病例報告

黃堂修(Tang-Hsiu Huang) ； 張漢煜(Han-Yu Chang)

《胸腔醫學》 25卷2期 (2010/04) Pp. 104-109

https://doi.org/10.29806/TM.201004.0009

摘要

過度動態性呼吸道塌陷臨床上呈現出阻塞型呼吸障礙的相關症狀，容易和其它常見的阻塞性呼吸道疾病或是氣管支氣管軟化症混淆。因此過去文獻上相關的專論並不多，近幾年才逐漸引起重視。我們在此報告一個病例：一位八十六歲的女性，因屢次下呼吸道感染而反覆接受氣管內插管及呼吸器使用，其中第二次住院時併發急性呼吸窘迫症，在接受呼吸器治療期間其呼吸道常暴露於較高之氣道壓力之下，儘管稍後病人整體臨床狀況改善，卻始終無法順利移除呼吸器，且經常產生喘鳴及氣促的情形，經由動態性胸腔電腦斷層掃描及支氣管鏡的檢查，診斷出有過度動態性呼吸道塌陷。我們藉由這樣的病例報告，提醒臨床醫師在診治表現有阻塞性呼吸道症狀乃至於呼吸器依賴的病人時，亦須將過度動態性呼吸道塌陷列入鑑別診斷中考慮。

關鍵字

氣管支氣管軟化症 ； 氣管支氣管壁 ； 持續呼吸道正壓

並列摘要

The normal airway lumen exhibits transient and partial narrowing during forceful expiration, which is known as ”dynamic airway collapse” (DAC). Excessive DAC (EDAC) results from transient and exaggerated invagination of the membranous posterior tracheobronchial wall, probably due to weakening of the intrinsic elastic tissues, and may impair ventilation and secretion clearance. In this report, we described a female who initially received endotracheal intubation because of severe pneumonia with respiratory failure, during which high cuff pressures and high levels of positive end-expiratory pressure were utilized. Despite having no known history of cigarette smoking, chemical exposure or underlying airway disorder, she subsequently developed frequent expiratory wheeze recalcitrant to inhalational bronchodilators, recurrent low-airway infections, and eventually difficult weaning from mechanical ventilation. Further surveys, including dynamic computed tomographic scan and bronchoscopy, revealed EDAC. The severity of her airway symptoms improved following the use of continuous positive airway pressure. In conclusion, EDAC clinically mimics common obstructive ventilatory disorders. Physicians should remain alert to this disorder, particularly when managing patients with refractory obstructive airway symptoms and difficult weaning.

並列關鍵字

tracheobronchomalacia ； tracheobronchial wall ； continuous positive airway pressure