Myšíková D, Simonek J, Stolz A, Lischke R
Chirurgicka Klinika 1. LF UK a FN Motol, prednosta kliniky.
Rozhl Chir. 2013 Jun;92(6):333-6.
Reexpansion pulmonary oedema is a rare but possibly lethal complication of thoracic drainage for pneumothorax. Morbidity and mortality of this complication remains high (up to 20% of lethal cases) and as such deserves our attention. We report a case of ipsilateral left-sided pulmonary oedema following chest tube insertion in a 42-year-old male patient with spontaneous pneumothorax. Pneumothorax can be expected to last for up to 3 weeks (from the first presentation of sudden dyspnoea and chest pain). The pathophysiology of this lung affection has not yet been completely elucidated; the crucial role is probably played by damage to the endothelium which is followed by increased endothelial permeability during ischemia-reperfusion injury in a rapidly reexpanding lung. The main risk factors for the development of RPE are young age (the younger the patient, the higher the risk), the female sex, the degree of lung collapse, a pneumothorax that lasts more than 24 hours, a reexpansion of the lung in less than ten minutes, the use of a suction system, and - in cases of a pleural effusion - an evacuation volume of more than 2000 ml. Although in patients with these risk factors the administration of initial negative pressure should be avoided, this procedure remains common practice in pneumothorax treatment in the Czech Republic. Thoracic surgeons are more likely to use the suction system than pulmonologists (70% versus 52%). RPE manifestation ranges from benign clinical course (patients are free of complaints with only pathological chest radiography findings) to potentially lethal rapid respiratory failure with circulatory shock. Most patients develop RPE within 1 hour of expansion and the ipsilateral lung is affected. Only rarely can pulmonary oedema be bilateral, or in the contra-lateral lung. Treatment of RPE is supportive and depends on the individual patients condition, ranging from mere monitoring to mechanical ventilation for serious cases. Positive pressure mechanical ventilation and the utilization of positive end-expiratory pressure (PEEP) remains the gold standard of treatment.
复张性肺水肿是气胸胸腔引流罕见但可能致命的并发症。该并发症的发病率和死亡率仍然很高（致死病例高达20%），因此值得我们关注。我们报告一例42岁男性自发性气胸患者在插入胸管后发生同侧左侧肺水肿的病例。气胸预计可持续长达3周（从首次突发呼吸困难和胸痛开始）。这种肺部疾病的病理生理学尚未完全阐明；关键作用可能由内皮损伤发挥，随后在快速复张的肺的缺血再灌注损伤期间内皮通透性增加。复张性肺水肿发生的主要危险因素包括年轻（患者越年轻，风险越高）、女性、肺萎陷程度、持续超过24小时的气胸、在不到十分钟内肺复张、使用吸引系统，以及在胸腔积液的情况下，引流量超过2000 ml。尽管对于有这些危险因素的患者应避免初始负压抽吸，但在捷克共和国，这种操作仍是气胸治疗中的常见做法。胸外科医生比肺科医生更可能使用吸引系统（分别为70%和52%）。复张性肺水肿的表现范围从良性临床过程（患者无不适主诉，仅胸部X线检查有病理表现）到伴有循环休克的潜在致命性快速呼吸衰竭。大多数患者在肺复张后1小时内发生复张性肺水肿，且同侧肺受累。肺水肿很少双侧发生或出现在对侧肺。复张性肺水肿的治疗是支持性的，取决于个体患者的情况，从单纯监测到严重病例的机械通气。正压机械通气和使用呼气末正压（PEEP）仍然是治疗的金标准。
