Inoue Y, Fukutome T, Uehara J, Koujiro M
Division of Anesthesia, Kyushu Koseinenkin Hospital, Kitakyushu.
Masui. 1994 Mar;43(3):395-9.
Cardiac surgery was performed on a 50-yr-old man suffering from mitral valve stenosis. He has no history of allergic disease or bronchial asthma. Mitral valve was replaced uneventfully under extracorporeal circulation, and ventilation with pure oxygen was tried. But the lung was so stiff that the bag of anesthetic circuit could not be squeezed by hand. Fiberoptic bronchoscopy revealed no obstruction in endotracheal tube or bronchial tree. A presumptive diagnosis of severe bronchospasm was made, and partial extracorporeal circulation was maintained. Soon after aggressive bronchodilator therapy, there was noticeable improvement in pulmonary compliance, and the patient was removed from bypass uneventfully. No further recurrence of bronchospasm was seen in the intra- or postoperative period. Although the exact causes for bronchospasm in our case are not clear, we concluded that severe bronchospasm was induced by extracorporeal circulation. Possible etiologies and the management of patients with this problem are reviewed.
对一名患有二尖瓣狭窄的50岁男性进行了心脏手术。他没有过敏性疾病或支气管哮喘病史。在体外循环下顺利进行了二尖瓣置换术，并尝试用纯氧通气。但肺部非常僵硬，麻醉回路的气囊无法用手挤压。纤维支气管镜检查显示气管内导管或支气管树无阻塞。做出了严重支气管痉挛的初步诊断，并维持部分体外循环。在积极的支气管扩张剂治疗后不久，肺顺应性有明显改善，患者顺利脱离体外循环。术中及术后均未再出现支气管痉挛复发。虽然我们病例中支气管痉挛的确切原因尚不清楚，但我们得出结论，严重支气管痉挛是由体外循环诱发的。本文对该问题患者的可能病因及处理方法进行了综述。
