Akay Mehmet H, Frazier O H
Department of Cardiopulmonary Transplantation and the Center for Cardiac Support, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.
Heart Surg Forum. 2012 Feb;15(1):E46-8. doi: 10.1532/HSF98.20111071.
Thoracic compartment syndrome has been observed after trauma and after mediastinal and cardiac procedures; however, an adult respiratory distress syndrome (ARDS)-like presentation has not been described as a part of thoracic compartment syndrome. We describe the case of an obese patient who underwent coronary artery bypass (his third such procedure) and hiatal hernia reduction during the same operation, followed by transmyocardial laser revascularization and full chest closure the next day. The patient was hypoxic after chest closure. Two days later, his peak airway pressure increased, and his cardiac and urine outputs decreased. Chest radiography findings suggested ARDS without hemodynamic instability. After we reopened the sternal incisions, the patient's symptoms reversed. Although our patient initially appeared to have ARDS, we believe the organ-volume displacement that occurred during the lengthy dual operation produced a thoracic and abdominal compartment syndrome that responded to decompression of the chest.
创伤后以及纵隔和心脏手术后已观察到胸廓间隔综合征；然而，类似成人呼吸窘迫综合征（ARDS）的表现尚未被描述为胸廓间隔综合征的一部分。我们描述了一例肥胖患者的病例，该患者在同一手术中接受了冠状动脉搭桥术（他的第三次此类手术）和食管裂孔疝修复术，次日进行了心肌激光血运重建术并完全关闭胸腔。关闭胸腔后患者出现低氧血症。两天后，他的气道峰压升高，心输出量和尿量减少。胸部X线检查结果提示ARDS但无血流动力学不稳定。我们重新打开胸骨切口后，患者的症状得到缓解。尽管我们的患者最初似乎患有ARDS，但我们认为在长时间的双重手术过程中发生的器官容积移位导致了胸廓和腹部间隔综合征，而胸部减压对此有反应。
