Frazer Ricky, Deane Crawford, Sabit Ramsey
University Hospital Llandough, Penlan Road, Llandough, UK.
BMJ Case Rep. 2011 Feb 17;2011:bcr1220103563. doi: 10.1136/bcr.12.2010.3563.
This is a case of a 45-year-old woman, with known alcoholic liver disease who presented with a large right-sided pleural effusion. A pleural tap was performed followed by insertion of an intercostal drain. 7 litres were drained over 4 h and only 300 ml of 20% albumin were administered with the patient becoming acutely short of breath and requiring admission to the intensive treatment unit due to the development of the known and recognised complication of re-expansion pulmonary oedema. The patient required continuous positive airway pressure in an intensive care setting but made a good recovery. It is important to consider re-expansion pulmonary oedema in patients who become acutely short of breath during drainage of pleural fluid or air. Steps should be made to ensure that drainage of large volumes of fluid are performed in a controlled manner to avoid this preventable complication.
这是一例45岁女性患者，患有酒精性肝病，出现右侧大量胸腔积液。进行了胸腔穿刺，随后插入肋间引流管。4小时内引出7升液体，仅给予300毫升20%的白蛋白，患者随即出现急性呼吸急促，因发生了公认的再扩张性肺水肿这一并发症而需要入住重症治疗病房。患者在重症监护环境中需要持续气道正压通气，但恢复良好。对于在胸腔积液或积气引流过程中出现急性呼吸急促的患者，考虑再扩张性肺水肿很重要。应采取措施确保以可控方式进行大量液体的引流，以避免这种可预防的并发症。
