Benaragama Kapila Shanka, Cemal Yeliz, Lindsey Ben, England Adrian
Centre for Nephrology & Transplantation, Royal Free London NHS Trust, London, UK.
BMJ Case Rep. 2014 Apr 25;2014:bcr2013009133. doi: 10.1136/bcr-2013-009133.
Facial oedema leading to airway compromise immediately after surgery is a rare event. We report a case of acute facial swelling sufficient to cause a significant obstruction of the patient's airway in recovery. We believe it was caused by partial obstruction of the venous drainage from the head associated with a sudden and large fluid load. A 35-year-old man underwent a live ABO-incompatible renal transplantation during which a central line was inserted into the right subclavian vein and a large volume of fluid was given intraoperatively. He also had a longstanding permacatheter on the left side used for haemodialysis. In the recovery room he developed acute facial swelling which did not resolve with steroids or antihistamines. He was managed by intubation of his airway and ventilation in the intensive care unit overnight before he made a complete recovery with no further intervention. We hypothesise that this event was related to an impaired venous return from his head secondary to the central venous line and the permacatheter partially obstructing the venous drainage from his head and neck combined with an acute large venous fluid load.
术后立即出现面部水肿导致气道受压是一种罕见事件。我们报告一例急性面部肿胀病例，肿胀严重到足以在患者恢复过程中导致气道明显梗阻。我们认为这是由与突然大量液体负荷相关的头部静脉引流部分受阻所致。一名35岁男性接受了活体ABO血型不相容肾移植，术中将中心静脉导管插入右锁骨下静脉并给予大量液体。他左侧还有一根长期使用的用于血液透析的永久性导管。在恢复室，他出现急性面部肿胀，使用类固醇或抗组胺药后肿胀未消退。他在重症监护病房接受了气道插管和通气治疗，过夜后完全康复，无需进一步干预。我们推测该事件与中心静脉导管和永久性导管部分阻碍头颈部静脉引流继发的头部静脉回流受损以及急性大量静脉液体负荷有关。
