Chechani V, Vasudevan V P, Kamholz S L
Department of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY.
South Med J. 1991 Feb;84(2):271-3.
A 51-year-old woman had localized interstitial pneumonia that rapidly progressed to involve all lung fields. After 9 days of conventional mechanical ventilation, pneumothorax developed in the presence of an obstruction of the right main bronchus. Bronchoscopy and endobronchial biopsies revealed NTB involving the tracheobronchial tree distal to the tip of the endotracheal tube, with complete obstruction of the right main bronchus by hard, eschar-like material. Tracheal mucosa proximal to the tip of the endotracheal tube was normal. Subsequent bronchoscopy, 20 days later, showed marked resolution of NTB. Though a frequent complication of mechanical ventilation in the neonate, NTB as a complication of conventional mechanical ventilation has not previously been recognized in an adult. Necrotizing tracheobronchitis should be suspected in adults who have had mechanical ventilation and who are experiencing ventilatory difficulties, after routine problems have been treated or excluded.
一名51岁女性患有局限性间质性肺炎，病情迅速进展至累及全肺野。在进行9天的传统机械通气后，出现了气胸，同时伴有右主支气管阻塞。支气管镜检查及支气管活检显示，非结核分枝杆菌（NTB）累及气管插管尖端远端的气管支气管树，右主支气管被坚硬的焦痂样物质完全阻塞。气管插管尖端近端的气管黏膜正常。20天后的后续支气管镜检查显示NTB明显消退。虽然NTB是新生儿机械通气的常见并发症，但此前在成人中尚未被认定为传统机械通气的并发症。对于接受过机械通气且在常规问题得到处理或排除后仍存在通气困难的成人，应怀疑有坏死性气管支气管炎。
