Yeh Yu-Ling, Lin Su-Man, Hu Jenkin S, Tsou Mei-Yung, Tsai Shen-Kou, Chu Ya-Chun
Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Acta Anaesthesiol Taiwan. 2005 Jun;43(2):117-21.
Superior vena cava (SVC) syndrome mostly presents the typical and unmistakable symptoms and signs, such as edema and venous distension of the face, neck, arms, and upper chest wall. Dyspnea and symptoms of airway obstruction are often the complaints of conscious patients. However, SVC syndrome if develops intraoperatively may become indistinguishable in view of the lack of utterable complaints of the patient and variable degrees of clinical presentation. We present a male patient who sustained an iatrogenic subclinical SVC syndrome in the course pneumonectomy. Airway obstruction was initially noted during the replacement of the double lumen endobronchial tube (DLT) by an ordinary endotracheal tube at the end of operation, which threw the patient into an acute precarious condition. Although he was conservatively treated with thrombolytic agent and anticoagulant, the patient eventually expired due to pulmonary embolism. The possible reasons for delayed diagnosis, intraoperative management, and prognosis of this case are discussed.
上腔静脉（SVC）综合征大多表现出典型且明确无误的症状和体征，如面部、颈部、手臂及上胸壁的水肿和静脉扩张。呼吸困难和气道梗阻症状常是清醒患者的主诉。然而，如果SVC综合征在术中发生，鉴于患者无法诉说症状且临床表现程度各异，可能难以辨别。我们报告一名男性患者，在肺切除术中发生了医源性亚临床SVC综合征。在手术结束时用普通气管内导管替换双腔支气管导管（DLT）时，最初发现气道梗阻，这使患者陷入急性危险状态。尽管对其进行了溶栓剂和抗凝剂的保守治疗，但患者最终因肺栓塞死亡。本文讨论了该病例延迟诊断、术中处理及预后的可能原因。
