Okutani D, Kotani K, Nagai T, Makihara S
Department of Surgery, Minami-Okayama Medical Center, Okayama, Japan.
Kyobu Geka. 2009 Mar;62(3):231-4.
Amyotrophic lateral sclerosis (ALS) is a progressive and fatal disease. To support breathing of some patients with ALS in its severe condition, mechanical ventilation is indispensable. However, mechanical ventilation has been known to induce pneumothorax by the damage of lung cells in response to mechanical stretch. An ALS 50-year-old male on mechanical ventilation was referred to our department for left pneumothorax. After an unsuccessful drainage for a couple of weeks, he underwent a partial resection of the left lung. On 3rd postoperative day (POD) the left lung collapsed again. Moreover, on 6th POD, the right pneumothorax occurred. Regarding the right pneumothorax, drainage was effective with a continuous pressure of -10 cm H2O, and the chest tube was removed soon. An air leak from the left chest tube persisted, and the left lung expansion was not enough with its apex line around the clavicle. On 42nd POD, a drainage pressure was increased up to -15 cm H2O. Then an air leak disappeared, and the lung expansion was obtained. The adjustment of a chest tube drainage pressure seems to be important, especially when a pneumothorax patient on mechanical ventilation is treated.
肌萎缩侧索硬化症（ALS）是一种进行性致命疾病。为了支持一些重症ALS患者的呼吸，机械通气必不可少。然而，众所周知，机械通气会因机械拉伸导致肺细胞损伤而诱发气胸。一名接受机械通气的50岁男性ALS患者因左侧气胸被转诊至我科。经过数周引流失败后，他接受了左肺部分切除术。术后第3天（POD），左肺再次塌陷。此外，在术后第6天，右侧气胸发生。对于右侧气胸，持续负压-10 cm H2O的引流有效，胸腔引流管很快拔除。左侧胸腔引流管持续漏气，左肺扩张不足，肺尖线位于锁骨周围。在术后第42天，引流压力增加至-15 cm H2O。随后漏气消失，肺实现扩张。胸腔引流管压力的调整似乎很重要，尤其是在治疗接受机械通气的气胸患者时。
