Acute Pulmonary Congestion with Hypoxemia in Construction of Arteriovenous Graft--A Case Report

動靜脈瘻管術中發生急性肺充血合併低血氧－病例報告

黃貽暄(Yi-Hsuan Huang) ； 呂志成(Chi-Cheng Lu) ； 李中毅(Chung-Yi Lee) ； 葉春長(Chun-Chang Yeh) ； 廖文進(Wen-Jinn Liaw) ； 鄭澄寰(Chen-Hwan Cherng) ； 林信隆(Shinn-Long Lin)

《重症醫學雜誌》 13卷3期 (2012/09) Pp. 158-162

https://doi.org/10.30035/TCCM.201209.0005

摘要

我們報告一個動靜脈瘻管手術後入住加護病房之病例，接受全身麻醉進行左側鎖骨下動靜脈人工移植管端對邊吻合術10分鐘之後，病人突然出現低血氧及壓脈帶無法測量出血壓情形，理學檢查發現雙側肺囉音以及頸靜脈怒張，臨床上高度懷疑醫源性左至右的分流導致急性肺充血，外科將動脈及人工移植管吻合端開口縮減後，症狀隨即改善。這是一個動靜脈瘻管手術術中出現的急性病發症，並討論在麻醉狀況下，藉由臨床表徵應快速判斷可能的原因並儘速處理，以減少嚴重後遺症的發生。

關鍵字

動靜脈瘻管手術 ； 急性肺充血 ； 左至右的分流

並列摘要

A 73-year-old female underwent an arteriovenous shunt and received general anesthesia. Desaturation and undetectable blood pressure suddenly developed 10 min after construction of an end-to-side anastomosis of a polytetrafluoroethylene graft between the left subclavian artery and the vein. Physical examinations revealed basal rales in both lungs and jugular venous distension. An iatrogenic left-to-right shunt induced acute pulmonary congestion was highly suspected. Access banding of the anastomosis from the artery to the polytetrafluoroethylene graft was immediately performed. The symptoms improved soon thereafter and postoperative intensive care was advised. The patient was discharged one week later without any other complications.

並列關鍵字

Arteriovenous shunt ； Acute pulmonary congestion ； Left-to-right shunt