Respiration. 2018;95(6):465-468. doi: 10.1159/000487712. Epub 2018 Apr 20.
Stenting at the flow-limiting segment can improve the ventilation-perfusion ratio in patients with central airway stenosis. However, there is no quantitative examination for assessing the perfusion status during interventional bronchoscopy. Intrabronchial capnography can estimate regional gas exchange by measuring carbon dioxide concentration. We herein report a case of bilateral bronchial stenosis where stenting was able to improve ventilation-perfusion ratio using intrabronchial capnography. A 44-year-old man was admitted to our institution with orthopnea. Chest computed tomography showed an extrinsic compression at the bilateral main bronchus and right pulmonary artery due to a mediastinal mass. After introduction of general anesthesia, arterial oxygen tension suddenly decreased in the supine position. After initial stenting, an increase was seen in ventilation at the right lung; however, a ventilation-perfusion mismatch occurred due to an increase in dead-space ventilation at the right pulmonary artery stenosis. Intrabronchial capnography was an effective modality to confirm the regional perfusion status during interventional bronchoscopy in real time.
在狭窄的气道中心部位放置支架可以改善中心气道狭窄患者的通气-灌注比例。然而，在介入性支气管镜检查期间，没有用于评估灌注状态的定量检查。支气管内二氧化碳描记术可以通过测量二氧化碳浓度来估计区域气体交换。本文报告了一例双侧支气管狭窄的病例，支气管内二氧化碳描记术显示支架置入术可以改善通气-灌注比例。一名 44 岁男性因端坐呼吸而被收入我院。胸部 CT 显示由于纵隔肿块导致双侧主支气管和右肺动脉的外压性狭窄。全身麻醉诱导后，患者仰卧位时动脉血氧分压突然下降。初次支架置入后，右肺通气增加；然而，由于右肺动脉狭窄处死腔通气增加，出现通气-灌注不匹配。支气管内二氧化碳描记术是一种实时确认介入性支气管镜检查期间区域性灌注状态的有效方法。
