Lang S A, Duncan P G, Shephard D A, Ha H C
Department of Anaesthesia, University of Saskatchewan, University Hospital, Saskatoon, Canada.
Can J Anaesth. 1990 Mar;37(2):210-8. doi: 10.1007/BF03005472.
The purpose of this review is to describe the pathogenesis of pulmonary oedema associated with upper airway obstruction, summarize what is known of its clinical presentation, and reflect upon its implications for the clinical management of airway obstruction. The pathogenesis of pulmonary oedema associated with upper airway obstruction is multifactorial. However, as the phrase "negative pressure pulmonary oedema" suggests, markedly negative intrapleural pressure is the dominant pathophysiological mechanism involved in the genesis of pulmonary oedema associated with upper airway obstruction. The frequency of the event is impossible to ascertain from the literature but paediatric cases requiring airway intervention for croup or epiglottitis and adults requiring airway intervention for emergence laryngospasm or upper airway tumours account for over 50 per cent of the documented cases in each age group, respectively. Individuals at risk should be observed closely while they remain at risk. The majority of cases present within minutes either of the development of acute severe upper airway obstruction or of relief of the obstruction. Resolution is typically rapid, over a period of a few hours. Rarely is anything more required for management than the maintenance of a patent airway, supplemental oxygen, and, in approximately 50 per cent of cases, mechanical ventilation and positive end-expiratory pressure.
本综述的目的是描述与上气道梗阻相关的肺水肿的发病机制，总结其临床表现的已知情况，并思考其对气道梗阻临床管理的意义。与上气道梗阻相关的肺水肿的发病机制是多因素的。然而，正如“负压性肺水肿”这一表述所提示的，显著的胸膜腔内负压是与上气道梗阻相关的肺水肿发生过程中主要的病理生理机制。从文献中无法确定该事件的发生率，但因喉炎或会厌炎需要气道干预的儿科病例以及因麻醉苏醒期喉痉挛或上气道肿瘤需要气道干预的成人病例，分别占各年龄组记录病例的50%以上。对处于风险中的个体，在其仍有风险时应密切观察。大多数病例在急性严重上气道梗阻发生或梗阻解除后的数分钟内出现。通常在数小时内即可迅速缓解。在处理方面，很少需要比维持气道通畅、补充氧气以及在大约50%的病例中进行机械通气和呼气末正压通气更多的措施。
