华西口腔医学杂志 ›› 2019, Vol. 37 ›› Issue (4): 450-452.doi: 10.7518/hxkq.2019.04.021

• 病例报告 • 上一篇    下一篇

喉痉挛继发负压性肺水肿1例

付静,王淼(),张虹,罗强   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院麻醉科,成都 610041
  • 收稿日期:2018-10-21 修回日期:2019-04-19 出版日期:2019-08-01 发布日期:2019-08-23
  • 通讯作者: 王淼 E-mail:60404408@qq.com
  • 作者简介:付静,主管护师,本科,E-mail:1213479791@qq.com

Negative pressure pulmonary edema secondary to laryngospasm: a case report

Jing Fu,Miao Wang(),Hong Zhang,Qiang Luo   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Anesthesia, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2018-10-21 Revised:2019-04-19 Online:2019-08-01 Published:2019-08-23
  • Contact: Miao Wang E-mail:60404408@qq.com

摘要:

负压性肺水肿是一种罕见的全身麻醉并发症。本文报道1例口腔手术患者在全身麻醉复苏过程中出现了急性负压型肺水肿。该患者为年轻男性,在全身麻醉下行双颌手术,术毕拔管出现喉痉挛,喉痉挛病情处理平稳保留鼻咽通气道,之后患者突发脉搏血氧饱和度下降,呼吸急促,口、鼻腔内吸出较多粉红色泡沫状分泌物,立即给予给氧辅助通气、利尿、激素等处理,病情控制。该例诊治过程提示:全身麻醉复苏过程中出现急性肺水肿时需高度怀疑负压性肺水肿,其治疗的首要原则是解除呼吸道梗阻,高浓度给氧辅助正压通气是减轻肺水肿的有效治疗措施。

关键词: 负压性肺水肿, 全身麻醉, 喉痉挛

Abstract:

Negative pressure pulmonary edema is a rare complication of general anesthesia. This paper presents a case of acute negative pressure pulmonary edema that occurred during general anesthesia resuscitation. The patient is a young male that underwent bimaxillary surgery under general anesthesia. Laryngospasm spasm ensued after extubation. The treatment for laryngeal spasm retained the smoothness of the nasopharyngal airway, and the pulse oxygen saturation rapidly decreased after anesthesia resuscitation. Pink foam sputum was sucked out from the cavity due to respiratory shortness from mouth and nose. Highly concentrated oxygen was immediately given to assist ventilation and as a symptomatic support (diuretics, hormones), and the condition evidently improved. The diagnosis and treatment of this case suggest that when acute pulmonary edema occurs during general anesthesia resuscitation, negative pressure pulmonary edema should be highly suspected. The first line of treatment is to relieve respiratory tract obstruction. Supplying highly concentrated oxygen to assist positive pressure ventilation is an effective treatment to alleviate pulmonary edema.

Key words: negative pressure pulmonary edema, general anesthesia, laryngospasm

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