The Clinical Characteristics of Negative Pressure Pulmonary Edema

負壓性肺水腫的臨床特性

吳仁光(Ren-Guang Wu)

《內科學誌》 26卷2期 (2015/04) Pp. 63-68

https://doi.org/10.6314/JIMT.2015.26(2).01

摘要

負壓性肺水腫（NPPE）是一種不常見的臨床症狀，其發生於呼吸道阻塞時，所引起的胸內負壓增加，造成水分移向肺組織間質。負壓性肺水腫可能發生在麻醉合併症，也可能發生在任何原因導致上呼吸道阻塞，或緩解慢性阻塞後的併發症，例如重症患者困難插管或呼吸器使用拔管後出現的呼吸窘迫與低氧血症。早期被診斷出來、呼吸道重新建立、適當的給氧及正壓呼吸器使用，達到有效的治療的目的。負壓性肺水腫常常發生於沒有明顯心臟衰竭危險因子的病患，許多是心肺功能正常或接近正常的病人，因而讓醫護同仁常常忽視了肺水腫的可能性。但如果未被立即辨識、確認，被誤認為其他的肺部急症而進行一系列不必要的檢查與治療，可能導致其他的併發症產生，在某些的文獻報告當中，其死亡率甚至可以高達40%。本篇綜論希望能提醒醫護同仁及早辨識與適當處置負壓性肺水腫，以避免病患不必要的併發症與死亡。

並列摘要

Negative pressure pulmonary edema (NPPE) or postobstructive pulmonary edema (POPE) is a form of noncardiogenic pulmonary edema that results from the generation of high negative intrathoracic pressure needed to overcome upper airway obstruction. It typically develops rapidly and can be life-threatening if not diagnosed promptly. Following an episode of acute airway obstruction or the relief of chronic upper airway obstruction, patients with NPPE develop sudden, unexpected and often severe pulmonary edema. Awareness of this uncommon condition is crucial if the physician is to make an early diagnosis and initiate successful treatment. NPPV may develop in several clinical situations follows a sudden, severe episode of upper airway obstruction, such as postanesthetic laryngospasm, postextubation laryngospasm, epiglottitis, croup, choking and strangulation. It also develops after surgical relief of chronic upper airway obstruction.

並列關鍵字

Negative pressure pulmonary edema ； Postobstructive pulmonary edema