Yamaguchi M, Toriyama S, Akaike T
Department of Anesthesia, Fujinomiya City General Hospital, Fujinomiya 418-0076.
Masui. 2001 Jan;50(1):59-61.
An 83-yr-old, 44-kg woman with a 2-month history of abdominal distension received diagnostic laparoscopy. Except for chronic treated hypertension, she was healthy. The preoperative chest X-ray demonstrated small pleural effusion occupying the lower left hemithorax, but she did not present with dyspnea or chest pain. After premedication with intravenous ranitidine 50 mg, anesthesia was induced with thiopental 150 mg, vecuronium 7 mg and maintained by 1-2% sevoflurane in 50% N2O/O2. SpO2 decreased after insufflation of CO2, but breath sound was audible on both lungs. At completion of operation, chest X-ray revealed the left hemilateral hydrothorax and 650 ml of pleural fluid was suctioned. Blood gas improved and the tracheal tube was removed. The diagnosis of tuberculous peritonitis was established by the demonstration of granulomas of the peritoneum. We speculated on four reasons for the increased pleural effusion on the left thorax: 1) Increase of systemic and capillary pressure caused by CO2 insufflation. 2) Increase of capillary permeability by tuberculous pleuritis. 3) Decrease of colloid osmotic pressure by hypoalbuminemia. 4) Decreased pleural fluid removal because of venous compression caused by increased intrathoracic pressure. Peritoneal insufflation of CO2 to create the pneumoperitoneum may induce hydrothorax in patients with tuberculous pleuritis.
一位83岁、体重44公斤、有2个月腹胀病史的女性接受了诊断性腹腔镜检查。除了经过治疗的慢性高血压外，她身体健康。术前胸部X线显示左下胸腔有少量胸腔积液，但她没有出现呼吸困难或胸痛。静脉注射50毫克雷尼替丁进行术前用药后，用150毫克硫喷妥钠、7毫克维库溴铵诱导麻醉，并用1% - 2%的七氟醚在50%氧化亚氮/氧气中维持麻醉。二氧化碳气腹后血氧饱和度下降，但双肺呼吸音可闻。手术结束时，胸部X线显示左侧胸腔积液，抽出650毫升胸腔积液。血气改善，气管导管拔除。通过腹膜肉芽肿的显示确诊为结核性腹膜炎。我们推测左侧胸腔积液增加有四个原因：1）二氧化碳气腹导致全身和毛细血管压力增加。2）结核性胸膜炎导致毛细血管通透性增加。3）低白蛋白血症导致胶体渗透压降低。4）胸腔内压力增加导致静脉受压，胸腔积液清除减少。向腹腔内注入二氧化碳制造气腹可能会诱发结核性胸膜炎患者出现胸腔积液。
