[肺动脉高压中血管源性支气管狭窄]

[Bronchial stenosis of vascular origin in pulmonary arterial hypertension].

作者信息

Turetta F, Bossi A, de Stefani R, Cannizzaro A, Simone M

机构信息

Servizio di Anestesia e Rianimazione, ULSS 36, Ospedale di Mestre, Venice, Italy.

出版信息

Ann Fr Anesth Reanim. 1988;7(3):261-3. doi: 10.1016/S0750-7658(88)80122-9.

DOI:10.1016/S0750-7658(88)80122-9

PMID:3044207

Abstract

A case is reported of bronchial stenosis due to a vascular cause in a patient with chronic obstructive lung disease, cor pulmonale and pulmonary arterial hypertension. This led to right lower lobe atelectasis and acute respiratory failure (pHa 7.24; PaCO2 85 mmHg; PaO2 44 mmHg) with important right-to-left shunting. This diagnosis was only suggested on day 7 by fibreoptic bronchoscopy and confirmed a week later by tomography and digital angiography. Nifedipine, used to reduce the pulmonary arterial hypertension, increased the cardiac index (31.min-1.m-2 to 3.3.1.min-1.m-2) and oxygen transport (488 ml.min-1.m-2 to 554 ml.min-1.m-2), despite increasing the shunt effect (Qs/QT: 26% to 31%). This and the antiinflammatory action of methylprednisolone were probably responsible for the favourable outcome.

摘要

报道了一例患有慢性阻塞性肺疾病、肺心病和肺动脉高压的患者因血管原因导致支气管狭窄的病例。这导致右下叶肺不张和急性呼吸衰竭（动脉血pH值7.24；动脉血二氧化碳分压85 mmHg；动脉血氧分压44 mmHg），伴有明显的右向左分流。该诊断在第7天通过纤维支气管镜检查才被提出，并在一周后通过断层扫描和数字血管造影得到证实。用于降低肺动脉高压的硝苯地平增加了心脏指数（从3.1 L·min⁻¹·m⁻²增至3.3 L·min⁻¹·m⁻²）和氧输送（从488 ml·min⁻¹·m⁻²增至554 ml·min⁻¹·m⁻²），尽管分流效应有所增加（分流率：从26%增至31%）。这以及甲泼尼龙的抗炎作用可能是导致良好预后的原因。