胸膜外肺切除术后即将发生张力性气胸导致的呼吸衰竭：一例报告
Respiratory failure caused by impending tension pneumothorax after extrapleural pneumonectomy: a case report.
作者信息
Sakuraba Sonoko, Omae Takeshi, Kawagoe Izumi, Koh Keito, Inada Eiichi
机构信息
Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka, 410-2295, Japan.
Department of Anesthesiology and Pain Medicine, School of Medicine, Juntendo University, Tokyo, Japan.
出版信息
JA Clin Rep. 2018 Jun 6;4(1):45. doi: 10.1186/s40981-018-0184-z.
BACKGROUND
Cardiac herniation is a serious postoperative complication of extrapleural pneumonectomy (EPP) and is reportedly preventable by reducing the suction pressure of the chest drain.
CASE PRESENTATION
We describe a patient in whom respiratory failure, which was caused by impending tension pneumothorax after EPP, was successfully treated via normal suction pressure of the chest drain. A lower suction pressure (- 7 cmHO) was chosen as an alternative to the setting typically used for postoperative drainage (- 15 cmHO). As a result, the wound in the chest wall functioned as an antireflux check valve, leading to the development of impending tension pneumothorax.
CONCLUSIONS
Impending tension pneumothorax presents with an abnormal elevation of intrapleural pressure on the affected side. This phenomenon can be effectively treated by increasing the suction pressure in the chest drain.
背景
心脏疝是胸膜外全肺切除术（EPP）术后的一种严重并发症，据报道通过降低胸腔引流管的吸引压力可预防。
病例介绍
我们描述了一名患者，其在EPP术后因即将发生张力性气胸而导致呼吸衰竭，通过胸腔引流管的正常吸引压力成功治疗。选择较低的吸引压力（-7cmH₂O）作为术后引流通常使用的设置（-15cmH₂O）的替代方案。结果，胸壁伤口起到了抗反流止回阀的作用，导致即将发生张力性气胸。
结论
即将发生的张力性气胸表现为患侧胸膜腔内压力异常升高。这种现象可通过增加胸腔引流管的吸引压力有效治疗。
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