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支气管占位性病变患者小脑病变切除术后再膨胀性肺水肿:一例报告

Re-expansion pulmonary edema after resection of cerebellar lesion in a patient with bronchial occupying lesion: A case report.

作者信息

Yu Jiang, Wang Ying, Chen Xuanyu, Cheng Ruozhu, Yang Xueli, Chen Hongzhi

机构信息

Department of Anesthesiology, Shengjing Hospital Affiliated to China Medical University, Shenyang, China.

出版信息

Medicine (Baltimore). 2019 Apr;98(15):e15046. doi: 10.1097/MD.0000000000015046.

Abstract

RATIONALE

Re-expansion pulmonary edema (RPE) is a non-cardiogenic pulmonary edema, and is secondary to pulmonary collapse caused due to various reasons. However, RPE is rarely encountered during non-thoracic surgeries and is associated with much higher risk than that occurring in thoracic surgeries.

PATIENT CONCERNS

Herein we have reported a case report of a 55-years-old male patient. Preoperative examination indicated occupying lesions in the bronchus and cerebellar hemisphere. Under general anesthesia, the patient received resection of cerebellar lesion and developed acute atelectasis, and RPE occurred when cannulation was withdrawn after re-expansion. Supportive and symptomatic treatment was given to the patient for recovery well.

DIAGNOSIS

RPE.

INTERVENTIONS

The trachea was cannulated and connected to a ventilator for assisted ventilation. The patient was also given symptomatic treatment including nebulization, diuresis, and anti-inflammation.

OUTCOMES

The patient recovered well and was discharged on day 8 after surgery.

LESSONS

Patients with occupying lesions of the airway should undergo bronchoscopy to determine the location, size, and distance of the lesion from the incisors. The anesthesiologists should determine appropriate anesthetic regimens according to the examination results to avoid acute atelectasis and postoperative pulmonary edema.

摘要

理论依据

复张性肺水肿(RPE)是一种非心源性肺水肿,继发于各种原因导致的肺萎陷。然而,RPE在非胸科手术中很少见,且与胸科手术中发生的RPE相比风险更高。

患者情况

在此我们报告一例55岁男性患者的病例。术前检查显示支气管和小脑半球有占位性病变。在全身麻醉下,患者接受了小脑病变切除术,术后出现急性肺不张,复张后拔管时发生了RPE。给予患者支持性和对症治疗后恢复良好。

诊断

RPE。

干预措施

气管插管并连接呼吸机进行辅助通气。患者还接受了包括雾化、利尿和抗炎在内的对症治疗。

结果

患者恢复良好,术后第8天出院。

经验教训

气道占位性病变患者应行支气管镜检查以确定病变的位置、大小以及距门齿的距离。麻醉医生应根据检查结果确定合适的麻醉方案,以避免急性肺不张和术后肺水肿。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd20/6485895/6923ab898c80/medi-98-e15046-g001.jpg

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