Otomo Asae, Kawatani Masako, Morikawa Tomoko, Nakazawa Kouichi, Makita Koshi
Department of Anesthesiology, National Cancer Center, Tokyo 104-0045.
Masui. 2004 Mar;53(3):291-3.
A 64-year-old woman was admitted to our hospital for removal of a thoracic tumor. Chest X-ray and computed tomography demonstrated a giant thoracic tumor occupying the right thorax, with the right lung almost completely collapsed and the mediastinum shifted to the left. Her preoperative pulmonary function studies revealed %vital capacity of 30%, and her oxyhemoglobin saturation was 92% (room air). Anesthesia was maintained with sevoflurane and fentanyl. The trachea was intubated with an armored tube because of severe tracheal shift. Operation was performed in the supine position. A Swan-Ganz catheter was inserted from the right femoral vein under fluoroscopy with stand-by of percutaneous cardiopulmonary support. The tumor was removed segmentally, and her right lung was inflated gradually. Two hours after removal of the tumor, PaO2 decreased to 74.2 mmHg (FIO2 1.0), and a large amount of sputum was suctioned subsequently. We suspected re-expansion pulmonary edema (RPE) and administered steroid with frequent tracheal suctioning. The patient was transferred to ICU without extubation. Postoperative X-ray demonstrated diffuse alveolar infiltrates over the right lung field. The patient was followed by respiratory management and body fluid management with diuretic drugs. The trachea was extubated on the following day, and her postoperative recovery was uneventful thereafter. We should consider the occurrence of RPE at removal of the giant thoracic tumor.
一名64岁女性因切除胸部肿瘤入住我院。胸部X线和计算机断层扫描显示一个巨大的胸部肿瘤占据右胸，右肺几乎完全塌陷，纵隔向左移位。她术前的肺功能研究显示肺活量为30%，氧合血红蛋白饱和度为92%（室内空气）。麻醉维持采用七氟烷和芬太尼。由于严重的气管移位，气管用钢丝强化气管导管插管。手术在仰卧位进行。在透视引导下从右股静脉插入一根Swan-Ganz导管，并准备好经皮心肺支持。肿瘤被分段切除，她的右肺逐渐复张。肿瘤切除两小时后，动脉血氧分压（PaO2）降至74.2 mmHg（吸入氧分数1.0），随后吸出大量痰液。我们怀疑是复张性肺水肿（RPE），并给予类固醇治疗，同时频繁进行气管吸引。患者未拔管被转入重症监护病房（ICU）。术后X线显示右肺野弥漫性肺泡浸润。患者接受呼吸管理和使用利尿剂进行体液管理。次日气管拔管，此后她的术后恢复顺利。在切除巨大胸部肿瘤时，我们应考虑复张性肺水肿的发生。
