Delayed Onset Negative Pressure Pulmonary Edema after General Anesthesia in a Young Man

一年輕男生在全身麻醉後出現延遲發作的負壓型肺水腫

洪鴻龍(Hung-Lung Hung) ； 邱耀輝(Yao-Hui Chiu) ； 陳文彬(Wen-Pin Chen)

《北市醫學雜誌》 9卷3期 (2012/09) Pp. 244-250

https://doi.org/10.6200/TCMJ.2012.9.3.06

摘要

負壓型肺水腫屬於非心因性肺水腫，是一種上呼吸道阻塞的併發症，常發生在全身麻醉的催醒期，多數案例的症狀在上呼吸道阻塞後數分鐘內即出現，延遲發作的情形很少見。此一特殊案例的案主為一年輕男學生，他在全身麻醉催醒期拔除氣管內管後發生喉頭痙攣，經處置後當時並無異狀，卻在延遲4小時後才在病房發生負壓型肺水腫。因時間落差，此種延遲發作的負壓型肺水腫對臨床鑑別診斷與治療都是一種挑戰。而所有經歷上呼吸道阻塞的病人，也都可能面臨此種風險。希望這篇報告能提高大家對負壓型肺水腫可能延遲發作的認知，尤其是要照顧麻醉後病人的醫療人員，更需有這種警覺性，才能避免延誤診斷與治療。

關鍵字

負壓型肺水腫 ； 延遲發作 ； 呼吸道阻塞 ； 喉頭痙攣

並列摘要

Negative pressure pulmonary edema (NPPE) is a form of non-cardiogenic pulmonary edema. NPPE usually arises as a consequence of upper airway obstruction during emergence from general anesthesia. Most cases develop symptoms within minutes following the inciting event. Delayed onset is uncommon. Here we describe a patient where negative pressure pulmonary edema occurred in a young schoolboy. It was induced by post-extubation laryngospasm after general anesthesia, but it had a postoperative delayed onset of up to 4 hours. Delayed onset NPPE can impose challenges in terms of differential diagnosis and treatment. It should be considered as a risk for any patient with a history of upper airway obstruction. We hope this case report will heighten alertness to this uncommon condition and serve as a reminder to physicians and nurses who care for post-anesthesia patients in other medical units. Such awareness should help to prevent any delay in diagnosis and treatment.

並列關鍵字

negative pressure pulmonary edema ； delayed onset ； airway obstruction ； laryngospasm