Acute Pulmonary Edema after Upper Airway Obstruction-A Case Report and Review of the Literature

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

於鍾傑(Chung-Chieh Yu) ； 謝文斌(Wen-Bin Shieh) ； 曾若琪(Jo-Chi Tseng) ； 劉育志(Yu-Chi Liu)

《胸腔醫學》 19卷6期 (2004/12) Pp. 476-483

https://doi.org/10.29806/TM.200412.0007

摘要

因上呼吸道阻塞引起的肺水腫被歸類為非心因性肺水腫或不明原因之肺水腫，呼吸道阻塞引起的肺水腫常伴隨著高死亡率，這是一種快速發生快速緩解的疾病，它可能發生於上呼吸道阻塞被緩解以後，這種肺水腫的病生理學包括胸腔內壓力的改變、血液動力學的改變、以及動脤缺氧等因素。急性肺出血可能伴隨肺水腫一起出現，它主要是上述病生理變化引起肺部微血管壓力衰竭而造成。
我們提出一位34歲的健康男性因食物過敏發生血管水腫而造成上呼吸道阻塞，由於嚴重上呼吸道阻塞而接受氣管插管，在上呼吸道阻塞緩解後，發生急性肺水腫以及肺出血，因此接受機城通氣以及針對血管水腫的藥物治療，經治療後，肺部狀況快速改答並且順利拔管，目前他已完全康復並無任何後遺症以及復發的情形。此病例的BAL洗出肺水腫液體與血漿蛋白質總量比例，經稀釋因數校正後為5.6%，故作者推測其肺水腫之病發生機轉靜液水柱壓變化耍比微血管通透性之改變來得顯著。

關鍵字

急性肺水腫 ； 急性肺出血 ； 上呼吸道阻塞 ； 血管水腫

並列摘要

Pulmonary edema induced by upper airway obstruction is classified as a disease of noncardiogenic or unclear origin, is associated with a high rate of mortality, and is typified by the rapid onset of a resolvable disease that may arise after the upper airway obstruction has been relieved. The possible pathophysiology of this type pulmonary edema involves intrathoracic pressure alternations, hemodynamic alternations, and arterial hypoxemia. Acute pulmonary hemorrhage may occasionally be associated with pulmonary edema, due to capillary stress failure resulting from the same pathophysiology.
In this report, we present our experience with a 34-year-old otherwise healthy male suffering from an upper airway obstruction caused by food allergy-aggravated angioedema. The patient was intubated because of the severe upper airway obstruction. Upon relief of the upper airway obstruction, the patient developed acute pulmonary edema and pulmonary hemorrhage. We administered mechanical ventilation and medical therapy for angioedema. His pulmonary status improved rapidly and he was extubated without further complications. He completely recovered without any sequel and was discharged from our hospital 8 days later. The total protein ratio of the lung edema fluid collected from the BAL, corrected with a dilution factor to plasma, was 5.6%. We inferred the change of hydrostatic pressure to be more predominant than the change in capillary permeability in this patient.

並列關鍵字

acute pulmonary edema ； acute pulmonary hemorrhage ； upper airway obstruction ； angioedema