原發性脊柱側彎及肺炎併發肺心症一病例報告

Idiopathic Scoliosis and Pneumonia Complicated with Cor Pulmonale Report of One Case

蕭志誠(Jyh-Chen Shiau) ； 黃健燊(Kin-Sun Wong) ； 黃嵩雀(Song-Chei Huang)

《Acta Paediatrica Sinica》 31卷1期 (1990/02) Pp. 58-63

摘要

病人是一十歲男孩，自小就有脊柱側彎，於住院前兩個星期，開始出現呼吸困難，腹水及下肢水腫。動脈血中二氧化碳分壓達95.7mmHg。心臓超音波顯示右心房，右心室及肺動脈擴大。心電圖顯示電軸偏右及右心房肥厚。胸部X光片顯示心臓擴大，肺部鬰血，兩側肺部下葉肺炎浸潤及再兩側胸肋膜積水。在使用呼吸器，抗生素，病人卻在一次發紺之後，發生心肺暫停，繼之陷入昏迷，家屬遂於隔天辦理自動出院而死亡。本篇就脊柱側彎合併肺心症的病因，診斷，治療及預後，參考文獻並加以討論。

並列摘要

A 10-year-old boy with idiopathic scoliosis presented with exertional dyspnea, lower leg edema since two weeks prior to admission. Physical examination revealed neck venous engorgement, moist rales, mild hepatomegaly, ascites and lower leg edema in addition to the scoliosis. Chest x-ray films showed cardiomegaly, pulmonary congestion and pneumonic infiltration of both lower lobes with bilateral pleural effusion. Electrocardiograms showed right axis deviation and right atrial hyperirophy. Two-dimensional echocardiography revealed dilatation of the right heart chambers and pulmonary artery. He was treated initially with mechanical ventilation, antibiotics, bronchodilators, diuretics, vasodilators, and digoxin with improvement. Unfortunately the patient became comatous after an episode of cardiopulmonary arrest. He did not recover from this tragedy and was discharged against medical advice in comatous state. Scoliosis may be complicated with pneumonia and cor pulmonale in children. Early surgical correction of the scoliosis may prevent the development of cor pulmonale. Combined medical and surgical managements should be carried out aiming at scoliotic heart disease.

並列關鍵字

scoliosis ； cor pulmonale ； scoliotic heart disease