Postobstructive Negative Pressure Edema Associated with Pulmonary Hemorrhage in an Intubated Patient During General Anesthesia: One Sporadic Case Report and Literature Review

插管病患在全身麻醉中，因肺癌血管破裂出血造成上呼吸道阻塞繼而誘發負壓性肺水腫病例並不常見，但其產生的急性肺水腫常伴隨著高死亡率。我們提出一位45歲女性病患，因工作時不慎被機械壓碎其左手食指，經手術醫師詳細檢查後，立即安排進行左手食指殘端形成術。麻醉前評估病患過往無抽煙習慣，但有肝炎和慢性咳嗽病史，術前胸部X光檢查於右肺近中隔處有明顯陰影，但比較去年的X光片，並無明顯差異（去年X光報告診斷為支氣管擴張）。給了病患施行氣管內插管之常規全身麻醉，麻醉過程順利。聽診時雙側呼吸音正常。手術進行30分鐘後，快接近手術結束時，發現病患已有自行呼吸現象，但突然病患之氣道壓力升高至40㎝ H_20，給予氣管內抽吸發現有大量粉紅色泡沫和血水。由於後續血氧濃度偏低，血壓偏低，發生不明原因之上呼吸道阻塞所產生的負壓肺水腫，該病患經積極治療肺水腫並於情況穩定後，送至加護病房照顧。後續追蹤其後發生原因，胸腔科醫師在支氣管鏡檢查發現術前X光片呈現於右肺近中隔處陰影，其實是肺腫瘤浸潤合併出血因而發生阻塞性負壓肺水腫。全身麻醉手術期間所發生非預期性急性肺水腫，由於病情變化快，早期快速正確的診斷和有針對性的治療措施是挽救病患生命的關鍵。在適當處理下，大多數病患在最初24小時內恢復，預後良好。本文旨在報告此一偶發病例，出現在全身麻醉氣管插管病人因顯著肺出血造成上氣道阻塞繼而引發負壓性肺水腫並做相關文獻回顧與討論。

關鍵字

負壓肺水腫；上呼吸道阻塞；肺腫瘤；全身麻醉

並列摘要

Negative pressure pulmonary edema accompanied by hemorrhage as a manifestation of upper airway obstruction secondary to lung cancer is an uncommon problem that is potentially life-threatening. This report presents a case of significant pulmonary hemorrhage and negative pressure pulmonary edema in an intubated patient during general anesthesia. Bronchoscopy showed tumor rupture with bleeding in the right lower lung lobe. We believe that in our case, pulmonary bleeding was due to disruption of the tumor capillaries during general anesthesia. Early diagnosis of pulmonary edema is very important because it affects the patient's postoperative morbidity and mortality. We discuss the possible causes and therapeutic approach, and we briefly review of literature.

並列關鍵字

negative pressure pulmonary edema ； upper airway obstruction ； lung cancer ； general anesthesia

國際替代計量

Postobstructive Negative Pressure Edema Associated with Pulmonary Hemorrhage in an Intubated Patient During General Anesthesia: One Sporadic Case Report and Literature Review

全文下載

主題瀏覽