Ahn Hyun-Joo, Yang Mikyung, Kim Jie Ae, Heo Burnyoung, Kim Jin-Kyoung, Park So Yoon
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2017 Aug;70(4):462-466. doi: 10.4097/kjae.2017.70.4.462. Epub 2017 May 19.
A patient with pulmonary alveolar proteinosis underwent whole lung lavage of the right lung. Lavage of the left lung was not immediately possible because of severe hypoxemia. Three days later, after correction of hypoxemia, we re-attempted the left lung lavage. However, the patient had severe hypoxemia (SpO < 80%) within a few minutes of performing right one lung ventilation (OLV). On bronchoscopic examination, proper tube location was confirmed. Bronchodilator nebulization and steroid injection were attempted with no effect. While searching for the cause of the hypoxemia, we found that the breath sound from the right lung had become very weak and distant compared with that from initial auscultation. Right pneumothorax was diagnosed on chest X-ray and a chest tube was inserted. After confirming pneumothorax resolution, we re-tried right OLV and were able to proceed with the left lung lavage without signs of aggravating air leak, loss of tidal volume, or severe hypoxemia.
一名肺泡蛋白沉着症患者接受了右肺全肺灌洗。由于严重低氧血症，当时无法立即对左肺进行灌洗。三天后，在低氧血症得到纠正后，我们再次尝试对左肺进行灌洗。然而，在进行右侧单肺通气（OLV）几分钟内，患者出现了严重低氧血症（SpO<80%）。经支气管镜检查，确认气管导管位置正确。尝试进行支气管扩张剂雾化和注射类固醇均无效。在寻找低氧血症原因的过程中，我们发现与最初听诊相比，右肺呼吸音变得非常微弱且遥远。胸部X线检查诊断为右侧气胸，并插入了胸管。在确认气胸消散后，我们再次尝试右侧OLV，并能够继续进行左肺灌洗，未出现漏气加重、潮气量丢失或严重低氧血症的迹象。
