Fujita Ayaka, Hashiba Eiji, Takahira Yoko, Kitayama Masatou, Tubo Toshihito, Hirota Kazuyoshi
Department of Anesthesiology, University of Hirosaki Hospital, Hirosaki 036-8563.
Masui. 2009 Oct;58(10):1274-7.
We report a case of bilateral giant bullae in a patient with multiple traumas. He had his arm amputated at the shoulder because of a machine accident and admitted to our hospital. Chest X-ray showed right-sided pneumothorax with bilateral giant bullae. Trimming of the stump was performed immediately after the placement of a right chest tube. He gradually developed hypoxia and hypercapnia with acidemia during the operation because of atelectasis due to sputum. Postoperatively, enlargement of right giant bulla led to frequent respiratory failure and he received a bilateral bullectomy through a median sternotomy 3 weeks after the accident. It was difficult to ventilate him due to air leak from the bilateral bulla and SpO2 dropped to below 70% with 100% oxygen. We continued the operation with standby extracorporeal membrane oxygenator (ECMO). Although the operation was finished without ECMO finally, ECMO had better been kept ready during anethesia with giant bullae when life threatening complication may occur at any point.
我们报告一例多发伤患者双侧巨大肺大疱的病例。他因机器事故导致肩部截肢，并入住我院。胸部X线显示右侧气胸伴双侧巨大肺大疱。在置入右侧胸管后立即进行了残端修整。术中因痰液导致肺不张，他逐渐出现缺氧、高碳酸血症并伴有酸血症。术后，右侧巨大肺大疱增大导致频繁呼吸衰竭，事故发生3周后，他通过正中胸骨切开术接受了双侧肺大疱切除术。由于双侧肺大疱漏气，给他通气困难，吸入100%氧气时血氧饱和度降至70%以下。我们在备用体外膜肺氧合（ECMO）的情况下继续手术。虽然手术最终未使用ECMO完成，但在麻醉有巨大肺大疱的患者时，当可能随时发生危及生命的并发症时，最好随时准备好ECMO。
