全身麻醉恢复期负压性肺水肿治疗分析  

Diagnosis and treatment of negative pressure pulmonary edema( NPPE) during general anesthesia recovery period

作　　者：江辉[1] 张雪[1] 李世勇[1] 罗爱林[1] 赵以林[1] JIANG Hui;ZHANG Xue;LI Shiyong(Department of Anesthesiology,Tonal Hospital of Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《临床外科杂志》2018年第11期868-870,共3页Journal of Clinical Surgery

基　　金：国家自然科学基金资助项目(81500982)

摘　　要：目的分析全身麻醉恢复期负压性肺水肿(NPPE)诊治的临床特点。方法回顾性分析我院16例全身麻醉恢复期发生的负压性肺水肿病人的临床资料。结果所有病人均发生拔除气管导管后气道梗阻,并在数分钟内出现气促、呼吸困难、发绀并咳出粉红色泡沫痰。12例病人进行再气管插管,4例病人没有插管。14例病人进入ICU。机械通气时间:10例<8小时,2例12小时撤机,症状好转。4例病人吸氧对症治疗,6～8小时恢复正常。12例病人听诊闻及湿啰音,并胸部X线平片增宽的血管影和双侧、中心性肺泡和间质的浸润征。4例病人单侧肺中心性肺泡和间质的浸润征。结论全身麻醉恢复期负压性肺水肿男性发生率高,且易发生年轻、ASAI级病人,其严重程度取决于病人梗阻时间。负压性肺水肿主要治疗方法为对症治疗,维持病人氧和。Objective To explore the diagnosis and treatment of NPPE during general anesthesia recovery period. Methods A retrospective investigation of clinical manifestation,imageology,clinical course and outcome of 16 cases with NPPE. Results All these cases presented with tachypnea,dyspnea,oxygen desaturation,rales and frothy sputum in few minute after upper airway obstruction. 12 cases was performed endotracheal intubation and were admitted to the ICU,four patients had no intubation. The duration of mechanical ventilation was less than 8 hours in 10 cases and 12 hours in two. Four patients were treated with oxygen inhalation,whose symptoms were obviously improved in 6 to 8 hours. In 12 cases chest radiography was performed and showed bilateral diffuse infiltrates. 4 cases displayed diffuse infiltrates in right lung. Conclusion NPPE is easily occurred in male,ASAI yong patients. The severity of NPPE is depended on obstruction of time. The main treatment of NPPE are symptomatic treatment,oxygen therapy timely with or without mechanical ventilation. Airway obstruction during general anesthesia recovery should be vigilant NPPE.

关 键 词：负压性肺水肿 梗阻性肺水肿 全身麻醉恢复期 气道梗阻 

分 类 号：R614.2[医药卫生—麻醉学]