先天性肺部呼吸道畸形術後呼吸照護經驗

Postoperative Respiratory Care for Congenital Pulmonary Airway Malformation

陳玥螢(Yueh-Yin Chen) ； 林鳳卿(Feng-Ching Lin) ； 許諄諄(Chun-Chun Hsu)

《呼吸治療》 17卷1期 (2018/07) Pp. 23-30

https://doi.org/10.6269/JRT.201807_17(1).0003

摘要

先天性肺部呼吸道畸形(congenital pulmonary airway malformation, CPAM)是一種罕見的下呼吸道發育異常疾病，發病原因尚不清楚。此病症可透過產前超音波檢查發現，並以手術切除治療。此病童在姙娠週數23週時經子宮超音波診斷右側肺部有CPAM，產後有呼吸窘迫現象，胸腔X光顯示病灶位於右中葉，壓迫右下肺葉導致部分肺塌陷及肺發育不全。經手術切除右中肺葉，使用高頻震盪通氣(high-frequency oscillatory ventilation, HFOV)維持氧合。術後產生氣胸合併症，使用HFOV配合胸管治療。待氣胸情況改善並維持穩定氧合，移除人工氣道，改非侵襲性正壓通氣(non-invasive positive pressure ventilation, NIPPV)支持。CPAM為一罕見發育異常之疾病，呼吸治療處置將影響病人預後，此病童在術後配合呼吸治療處置下成功拔管，使用NIPPV，故藉由此病童的呼吸照護經驗，探討先天性肺病變，並提供日後類似病例之呼吸器照護策略及治療處置方針。

關鍵字

先天性肺部呼吸道畸形 ； 高頻震盪通氣 ； 氣胸

並列摘要

Congenital pulmonary airway malformation (CPAM), also known as congenital cystic adenomatoid malformation (CCAM), is a rare developmental anomaly of lower respiratory tract, and the cause of CPAM is still unclear. Many cases are now detected by routine prenatal ultrasound examination. Surgical resection is the definitive treatment. The patient was diagnosed with right lung CPAM by the uterus ultrasound at 23 weeks gestation week, and had respiratory distress postnatally. Chest X-ray shows CPAM at right middle lobe, which compressed the right lower lobe and lead to partial atelectasis and pulmonary hypoplasia. The patient used high-frequency oscillatory ventilation (HFOV) to maintain the oxygenation after surgical excision. There was a complication of postoperative pneumothorax, and was treated by the use of chest tubes with HFOV. After pneumothorax improves with stable oxygenation, the artificial airway was removed, and non-invasive positive pressure ventilation (NIPPV) was used to support patient’s ventilation. CPAM is a rare developmental abnormalities of lung, and the respiratory treatments affect patients' outcomes. Due to the appropriate postoperative respiratory therapies, the artificial airway removed smoothly. Based on the respiratory care experience of this case, we can learn more about congenital lung diseases, and provide respiratory protection strategies and treatment guidelines for similar cases in the future.

並列關鍵字

congenital pulmonary airway malformation (CPAM) ； high-frequency oscillatory ventilation (HFOV) ； pneumothorax