Santacana E, Litvan H, Aris A, Montiel J, Villar-Landeira J M
Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona.
Rev Esp Anestesiol Reanim. 1993 Jul-Aug;40(4):230-3.
We present the case of a 69-year-old male bearing a Swan-Ganz catheter while undergoing aortic and mitral valve replacement. Massive hemorrhage through the endotracheal tube began after closure of the sternotomy. Selective endobronchial intubation was performed and the thorax immediately reopened to reveal a tear in the right pulmonary artery at the level of the middle lobar branch. The tear was sutured, and throughout the early postoperative hours the patient presented signs of active bleeding through thoracic drains, with persistent slight hemoptysis in the right branch of the endotracheal tube. Ventilation was controlled artificially with two synchronized respirators and positive end-expiratory pressure (PEEP) up to 10 cm H2O in the right lung. The double-lumen tube was removed after 15 days with no complications and the patient was released two months after surgery. Massive endobronchial hemorrhage resulting from perforation of the pulmonary artery or its tributaries caused by Swan-Ganz catheters requires early diagnosis and treatment based on airway protection and immediate location and control of the point of hemorrhage. Selective endobronchial intubation with double-lumen tubes, direct arterial surgery and use of PEEP may constitute a valid alternative for management of these patients, making resection unnecessary.
我们报告一例69岁男性在进行主动脉和二尖瓣置换手术时留置了Swan-Ganz导管。胸骨切开术关闭后，气管内导管出现大量出血。进行了选择性支气管内插管，并立即重新打开胸腔，发现中叶分支水平的右肺动脉有一处撕裂。撕裂处进行了缝合，在术后早期，患者通过胸腔引流管出现活动性出血迹象，气管内导管右支持续有轻微咯血。使用两台同步呼吸机进行人工控制通气，右肺呼气末正压（PEEP）高达10 cm H₂O。15天后双腔管拔除，无并发症，患者术后两个月出院。Swan-Ganz导管导致肺动脉或其分支穿孔引起的大量支气管内出血需要基于气道保护以及立即定位和控制出血点进行早期诊断和治疗。使用双腔管进行选择性支气管内插管、直接动脉手术和使用PEEP可能是治疗这些患者的有效替代方法，无需进行切除术。
