摘要
拔管後引起之肺水腫為一臨床急症。其可能是因拔管後喉部筋攣引起上呼吸道阻塞所造成。它的發生經常是快速而無預兆，並有可能導致嚴重的呼吸窘迫。極度的胸內負壓被認為是可能的發生機制。在適當的氧氣供應及支持性治療後，患者大都能迅速痊癒並且預後十分良好。我們在此提出一發生於健康中年男性之拔管後肺水腫病例報告。這位34歲男性病人因慢性鼻竇炎及鼻息肉而入院接受手術。手術過程順利，但病患拔管後突然發生呼吸困難並血氧濃度下降，胸部X光呈現雙側肺水腫，以右側肺野較為明顯。在適當的氧氣治療後，病患病況迅速回復並且肺野也很快變乾淨。該患者於術後五天出院，於門診追蹤並無發現任何不適後遺症。
並列摘要
Post-extubation pulmonary edema is a critical condition which may be the complication of upper airway obstruction due to post-extubation laryngospasm. Such an episode often develops quickly without warning and results in severe respiratory distress. An extreme intrathoracic negative pressure is considered to be the causative factor. After adequate oxygen supplementation and supportive treatment, patients often recover rapidly, and the prognosis is good. We herein present a case of post-extubation pulmonary edema in a healthy middle-aged male patient. This 34-year-old male patient was admitted to undergo an operation for chronic sinusitis and nasal polyps. The operation course was smooth but the patient developed dyspnea and hypoxemia soon after extubation. The chest radiograph revealed pulmonary edema. After adequate oxygen therapy, he recovered rapidly and the lung fields quickly cleared. The patient was discharged on the fifth postoperative day, with no sequel on the follow-up.
延伸閱讀
- Chang, C. H., Huang, K. S., Chen, Y. S., Man, K. M., Ma, C. L., & Liaw, W. J. (2015). 插管病患在全身麻醉中發生肺出血造成呼吸道阻塞性負壓肺水腫：偶發病歷報告及文獻回顧. 童綜合醫學雜誌, 9(1), 46-51. https://www.airitilibrary.com/Article/Detail?DocID=20713592-201506-201506290006-201506290006-46-51
- 陳憶如、吳孝存、徐郁琇、郭寶梅、林聖翔（2018）。【論文摘要】拔管後咽喉水腫合併負壓性肺水腫病人之呼吸照顧經驗。呼吸治療，17(1)，76-76。https://doi.org/10.6269/JRT.201807_17(1).0043
- 江長窈、曾稼志、陳宗鷹、蔡玉娟、陳冠廷、張傳林（1996）。拔管後因上呼吸道阻塞造成之肺水腫－兩個病例報告。Acta Anaesthesiologica Sinica，34(2)，97-102。https://doi.org/10.6955/AAS.199606.0097
- Liao, S. M., Liou, C. M., Hsu, S. C., & Lau, H. K. (2005). 拔管後因上呼吸道阻塞造成之肺水腫－病例報告. 中山醫學雜誌, 16(1s), 123-130. https://doi.org/10.30096/CSMJ.200506.0015
- Yu, C. C., Shieh, W. B., Tseng, J. C., & Liu, Y. C. (2004). 上呼吸道阻塞後所造成的急性肺水腫－病例報告及文獻回顧. 胸腔醫學, 19(6), 476-483. https://doi.org/10.29806/TM.200412.0007