Ono Rie, Fujino Yuji, Uchiyama Akinori, Nishimura Shinya, Nishimura Masaji, Taenaka Nobuyuki, Minami Masato, Mashimo Takashi
Intensive Care Unit, Osaka University Hospital, Suita 565-0871.
Masui. 2002 Jun;51(6):655-8.
A 35-yr-old woman presented with dyspnea has been diagnosed as having lymphangioleiomyomatosis (LAM). Despite treatment with estrogen, her pulmonary function deteriorated progressively. In January 2001, a left single-lung transplantation was performed on her from a cadaveric donor. On admission to the ICU after the transplantation, arterial blood gas analysis showed a severe respiratory acidosis. A double-lumen endotracheal tube (ETT) was replaced by a single-lumen ETT for a better suctioning of secretion. Gas exchange improved after the replacement of ETT and suctioning of secretion by bronchoscopy. Five hours after the admission to the ICU, the breath sound decreased over the right thorax. The chest X-ray showed right pneumothorax, and a chest tube was inserted. The patient was weaned from mechanical ventilation gradually and extubated on the 6th ICU day. The patient was discharged from ICU to the general ward on the 9th ICU day without pneumonia and other complications. The development of pneumothorax in the recipient lung should be kept in mind during the perioperative period of lung transplantation for LAM.
一名35岁的女性因呼吸困难就诊，被诊断为淋巴管平滑肌瘤病（LAM）。尽管接受了雌激素治疗，但其肺功能仍逐渐恶化。2001年1月，对她进行了尸体供体的左侧单肺移植。移植后入住重症监护病房（ICU）时，动脉血气分析显示严重呼吸性酸中毒。为了更好地吸痰，将双腔气管内插管（ETT）换成了单腔ETT。更换ETT并通过支气管镜吸痰后，气体交换得到改善。入住ICU 5小时后，右胸呼吸音减弱。胸部X线显示右侧气胸，遂插入胸管。患者逐渐脱离机械通气，并于ICU第6天拔管。患者于ICU第9天从ICU转入普通病房，未发生肺炎及其他并发症。对于LAM患者进行肺移植的围手术期，应注意受体肺发生气胸的情况。
