全身麻醉期间的过度动态气道塌陷：一例报告
Excessive dynamic airway collapse during general anesthesia: a case report.
作者信息
Murakami Shunichi, Tsuruta Shunsuke, Ishida Kazuyoshi, Yamashita Atsuo, Matsumoto Mishiya
机构信息
Department of Anesthesiology, Shuto General Hospital, Kogaisaku 1000-1, Yanai, Yamaguchi, 742-0032, Japan.
Department of Anesthesiology, Japan Community Healthcare Organization Tokuyama Central Hospital, Kodacho 1-1, Shunan, Yamaguchi, 745-8522, Japan.
出版信息
JA Clin Rep. 2020 Sep 28;6(1):73. doi: 10.1186/s40981-020-00380-1.
BACKGROUND
Excessive dynamic airway collapse (EDAC) is an uncommon cause of high airway pressure during mechanical ventilation. However, EDAC is not widely recognized by anesthesiologists, and therefore, it is often misdiagnosed as asthma.
CASE PRESENTATION
A 70-year-old woman with a history of asthma received anesthesia with sevoflurane for a laparotomic cholecystectomy. Under general anesthesia, she developed wheezing, high inspiratory pressure, and a shark-fin waveform on capnography, which was interpreted as an asthma attack. However, treatment with a bronchodilator was ineffective. Bronchoscopy revealed the collapse of the trachea and main bronchi upon expiration. We reviewed the preoperative computed tomography scan and saw bulging of the posterior membrane into the airway lumen, leading to a diagnosis of EDAC.
CONCLUSIONS
Although both EDAC and bronchospasm present as similar symptoms, the treatments are different. Bronchoscopy proved useful for distinguishing between these two entities. Positive end-expiratory pressure should be applied and bronchodilators avoided in EDAC.
背景
动态气道过度塌陷（EDAC）是机械通气期间气道压力升高的罕见原因。然而，麻醉医生对EDAC的认识并不广泛，因此，它常被误诊为哮喘。
病例报告
一名有哮喘病史的70岁女性接受七氟醚麻醉下行剖腹胆囊切除术。全身麻醉下，她出现哮鸣音、吸气压力升高及二氧化碳波形图上的“鲨鱼鳍”波形，被诊断为哮喘发作。然而，支气管扩张剂治疗无效。支气管镜检查显示呼气时气管和主支气管塌陷。我们回顾术前计算机断层扫描，发现后膜膨出进入气道腔，从而诊断为EDAC。
结论
尽管EDAC和支气管痉挛表现出相似症状，但治疗方法不同。支气管镜检查有助于区分这两种情况。对于EDAC应采用呼气末正压通气，避免使用支气管扩张剂。
Zotero 插件