Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2010 Dec;59 Suppl(Suppl):S163-6. doi: 10.4097/kjae.2010.59.S.S163. Epub 2010 Dec 31.
A 25-year-old woman was diagnosed with a ruptured ectopic pregnancy. During laparoscopic surgery, the patient was in the Trendelenberg position (20° degrees). Massive froth in the endotracheal tube was observed at the end of surgery. A portable chest x-ray, checked at the end of the operation, showed diffuse haziness in both upper lung fields. After one hour of aggressive treatment with drugs and positive mechanical ventilation, the amount of froth in the endotracheal tube was reduced considerably. Considering the symptom and radiologic findings, we concluded that diffuse bilateral upper lung field haziness was due to atypical pulmonary edema. We speculated that the rapid improvement of pulmonary edema was due to redistribution of fluid to the lowest part of lung by immediate reversing the patient's Trendelenberg position, along with aggressive treatment.
一位 25 岁的女性被诊断为破裂型宫外孕。在腹腔镜手术中，患者取头高脚低位（20°）。手术结束时，发现气管内有大量泡沫。手术结束时进行了便携式胸部 X 光检查，显示双肺上野弥漫性混浊。经过一小时的积极药物治疗和正压通气后，气管内的泡沫量明显减少。根据症状和影像学发现，我们诊断弥漫性双侧肺上野混浊是由于非典型性肺水肿。我们推测肺水肿的迅速改善是由于将患者头高脚低位迅速反转，同时进行积极治疗，使液体重新分布到肺的最低部分。
