Marandon J Y, Farkas J C
Départment d'Anesthésie-Réanimation, Hôpital Saint-Joseph, Paris.
Ann Fr Anesth Reanim. 1990;9(3):312-4. doi: 10.1016/s0750-7658(05)80194-7.
A case is reported of a 69-year-old man who sustained a total atelectasis of his right lung while undergoing ilio-tibial bypass surgery. This patient had a history of chronic obstructive pulmonary disease. The plain chest film showed a possible right-sided segmental atelectasis as well as pleural thickening on the same side. Lung function tests showed up a small obstructive syndrome, with mild hypoxaemia (Pao2 60.5 mmHg). The procedure was performed under epidural anaesthesia, carried out with 20 ml of 0.5% bupivacaine and 0.1 mg fentanyl. The upper level of anaesthesia was T4. The patient was sedated with flunitrazepam. He was given oxygen because arterial blood appeared to be somewhat dark. Despite this, the patient became grey, agitated, and had tachypnoea, together with absent breath sounds on the right side. A chest X-ray confirmed the diagnosis of total atelectasis of the right lung. Fiberoptic bronchoscopy was carried out, and a purulent mucous plug was removed. The patient improved and recovered from this episode totally. Blood gases were measured 1 month later; there was no difference with the preoperative values, except for correction of the hypoxaemia (Pao2 76 mmHg). The different factors possibly involved in the pathogenesis of the plug are discussed. It is likely that general anaesthesia would not have avoided this complication.
报道了一例69岁男性患者，在接受髂胫束搭桥手术时发生右肺完全肺不张。该患者有慢性阻塞性肺疾病史。胸部X线平片显示右侧可能存在节段性肺不张以及同侧胸膜增厚。肺功能测试显示有轻度阻塞性综合征，伴有轻度低氧血症（动脉血氧分压60.5 mmHg）。手术在硬膜外麻醉下进行，使用20毫升0.5%布比卡因和0.1毫克芬太尼。麻醉平面为T4。患者用氟硝西泮镇静。因动脉血看起来有些暗红，给予患者吸氧。尽管如此，患者面色发灰、烦躁不安、呼吸急促，右侧呼吸音消失。胸部X线证实了右肺完全肺不张的诊断。进行了纤维支气管镜检查，取出了脓性黏液栓。患者病情好转并完全康复。1个月后测量血气；除低氧血症得到纠正（动脉血氧分压76 mmHg）外，与术前值无差异。讨论了可能与栓子发病机制有关的不同因素。全身麻醉可能无法避免这种并发症。
