脓胸——术后——复张性肺水肿

此案报告63岁老年女性患左侧脓胸,实施脓胸扩清术发生复张性肺水肿(reexpansion pulmonary edema,RPE)的诊疗过程.在给予患者限制液体入量、利尿及药物治疗后,患者病情得到稳定和改善.RPE是胸科手术少见的术后并发症,鉴于其突发性以及存在不同程度的低氧血症、低血压或休克,对其诊断和处理应引起麻醉医师的重视.     

复张性肺水肿的治疗

目的 探讨复张性肺水肿（ＲＰＥ）的诊治和预防方法。方法 回顾性分析了１９７８￣１９９８年间所治疗的９例ＲＰＥ。结果 其中７例发生于自发性气胸（７／１４０）,２例发生于胸腔积液（２／４６）复张后。２例无临床症状,仅在胸片上有肺水肿征 治疗,８例痊愈,１例死亡。结论 ＲＰＥ的诊断治疗并不困难,预后良好,但如果延误诊治,可引起呼吸窘迫综合征或多器官功能衰竭,死亡率较高,在治疗病程较长的肺萎陷时,应逐步减     

胸腔镜手术中发生复张性肺水肿三例

胸腔镜手术中发生复张性肺水肿三例尤新民金熊元鲍泽民作者单位：２０００９２上海市第二医科大学新华医院麻醉科我院１９９４年１月以来电视胸腔镜手术８５例，其中３例术中发生严重复张性肺水肿，报告如下。例１．男，７７岁，６２ｋｇ，ＡＳＡⅡ～Ⅲ级。左胸膜恶性肿瘤...     

复张性肺水肿12例

复张性肺水肿是继发于各种原因引起的肺萎缩快速复张后的一种并发症 ,较为少见 ,本症可因呼吸循环衰竭致命 ,且其发生的潜在危险性在肺复张前不可能预测[1] 。1　临床资料1.1　一般资料 :1998年以来我院收治 12例患者 ,男 9例 ,女 3例 ,年龄 45～ 70岁。癌症合并胸腔积液 9例 ,气胸 2例 ,脓气胸 1例。临床表现 :9例癌症合并胸腔积液患者 ,3例抽出15 0 0ml ,6例抽出 5 0 0～ 80 0ml后 ,2h内出现呼吸困难、胸闷、顽固性咳嗽、咯粉红色泡沫痰 ,2 4～ 48h内病情呈现进展状态 ,查体可闻及湿罗音 ,X线胸片显示单肺或双肺浸润性阴影 ,如术中发现可…     

术中复张性肺水肿一例

复张性肺水肿(reexpansion pulmonary edema，RPE)是指因气胸、胸腔积液或纵隔巨大肿瘤造成的患侧肺萎陷，经胸腔闭式引流或切除肿瘤使萎陷的肺复张后，患肺在短时间内(3h内)发生的急性非心源性肺水肿。RPE多见于自发性气胸，创伤性气胸极为少见。     

胸腔闭式引流术后复张性肺水肿12例诊疗体会

目的总结胸腔闭式引流术后复张性肺水肿的诊疗体会。方法回顾分析2010-07—2015-06胸腔闭式引流术后12例复张性肺水肿患者的临床资料。结果 11例抢救成功,1例肺癌晚期患者抢救无效死亡。结论复张性肺水肿的发病与肺萎缩的时间及程度、胸腔闭式引流过程中气体、液体引流速度有关。其发病急,进展迅速,病情危重,但可预防。如早发现,及时给予有效的治疗可缓解病情,挽救生命。     

慢性萎陷肺术中复张性肺水肿：附5例报告

慢性萎陷肺术中复张性肺水肿（附５例报告）汪椿祜＊黄怡真＊我院自１９８４年以来１０余年间施行胸部手术３５００余例，术中并发萎陷肺急性复张性肺水肿５例，经及时治疗全部康复。现就临床资料以及对其发生机制和预防措施探讨报告如下。临床资料一般资料见表１。５例均...     

复张性肺水肿的诊断及治疗

1978年至 1999年 ,我们共收治复张性肺水肿病人 17例 ,现将诊疗经验报道如下。临床资料　本组男 12例 ,女 5例 ;年龄 9～ 6 2岁。自发性气胸 10例中 6例单侧和 2例双侧自发性气胸做胸腔闭式引流术后发生复张性肺水肿 ,2例单侧自发性气胸采用电视胸腔镜下滑石粉喷洒术治疗后发生复张性肺水肿。胸腔积液 6例 ,其中 1例为右侧胸腔积液经胸腔闭式引流术后发生左侧复张性肺水肿。1例纵隔巨大畸胎瘤切除术后发生复张性肺水肿。本组 17例病例均系经治疗使萎陷的肺复张后 ,15ｍｉｎ～6ｈ内病人出现不同程度气短、呼吸浅快、咳嗽频繁、咳大量白色或粉…     

胸腔闭式引流术后复张性肺水肿的诊治体会

目的:探讨复张性肺水肿的病因,临床表现以及治疗预防措施。方法:回顾性分析6例胸腔闭式引流术后复张性肺水肿的临床表现和诊断,治疗方法。结果:全组无死亡,1例给予呼吸机治疗,2天后顺利拔管。结论:复张性肺水肿是胸腔闭式引流术后少见但严重的并发症,治疗重点在于稳定病人的血流动力学,改善呼吸功能,临床上应该预防为主。     

Reexpansion Pulmonary Edema Due to High-Frequency Jet Ventilation: Report of a Case

Barotrauma is well known to be a relatively common complication of high-frequency jet ventilation (HFJV); however, the occurrence of reexpansion pulmonary edema (REPE) is extremely rare. We report herein a case of REPE caused by difficulties encountered with anesthesia using HFJV during video-assisted thoracic surgery (VATS) for a spontaneous pneumothorax. We believe the rapid increase in pressure in the lung after degassing for VATS resulted in REPE as well as typical barotrauma. Received: August 27, 1999 / Accepted: July 25, 2000     

Reexpansion pulmonary edema: review of pediatric cases

Reexpansion pulmonary edema (RPE) is an increased permeability pulmonary edema that usually occurs in the reexpanded lung after several days of lung collapse. This condition is recognized to occur more frequently in patients under the age of 40 years, but there has been no detailed analysis of reported pediatric cases of RPE to date. For this review, PubMed literature searches were performed using the following terms: ‘re(‐)expansion pulmonary (o)edema’ AND (‘child’ OR ‘children’ OR ‘infant’ OR ‘boy’ OR ‘girl’ OR ‘adolescent’). The 22 pediatric cases of RPE identified were included in this review. RPE was reported in almost the entire pediatric age range, and as in adult cases, the severity ranged from subclinical to lethal. No specific treatment for RPE was identified, and treatment was administered according to the clinical features of each patient. Of the 22 reported cases, 10 occurred during the perioperative period, but were not related to any specific surgical procedures or anesthetic techniques, or to the duration of lung collapse. Pediatric anesthesiologists should be aware that pediatric RPE can occur after reexpansion of any collapsed lung and that some invasive therapies can be useful in severe cases.     

Neurogenic pulmonary edema

Neurogenic pulmonary edema (NPE) is usually defined as an acute pulmonary edema occurring shortly after a central neurologic insult. It has been reported regularly for a long time in numerous and various injuries of the central nervous system in both adults and children, but remains poorly understood because of the complexity of its pathophysiologic mechanisms involving hemodynamic and inflammatory aspects. NPE seems to be under-diagnosed in acute neurologic injuries, partly because the prevention and detection of non-neurologic complications of acute cerebral insults are not at the forefront of the strategy of physicians. The presence of NPE should be high on the list of diagnoses when patients with central neurologic injury suddenly become dyspneic or present with a decreased P(a)o(2)/F(i)o(2) ratio. The associated mortality rate is high, but recovery is usually rapid with early and appropriate management. The treatment of NPE should aim to meet the oxygenation needs without impairing cerebral hemodynamics, to avoid pulmonary worsening and to treat possible associated myocardial dysfunction. During brain death, NPE may worsen myocardial dysfunction, preventing heart harvesting.     

舒更葡糖钠对胸腔镜肺切除术后恢复的影响

目的：探讨舒更葡糖钠对胸腔镜肺切除术后肺部并发症（PPCs）及术后恢复的影响。
方法：选择2021年11月至2023年7月接受择期胸腔镜肺段切除术或肺叶切除术的患者263例,男112例,女151例,年龄18～64岁,BMI 18.5～28.0 kg/m²,ASAⅠ—Ⅲ级。将患者随机分为三组：舒更葡糖钠组（S组,n=88）、新斯的明组（N组,n=87）和对照组（C组,n=88）。患者术后被送至PACU,当四个成串刺激（TOF）计数为2时,S组静脉注射舒更葡糖钠2 mg/kg,N组静脉注射新斯的明0.04 mg/kg+阿托品0.02 mg/kg,C组静脉注射等容量生理盐水。记录手术结束至出院前PPCs的发生情况,记录手术结束至拔管时间、给药至四个成串刺激比值（TOFr）恢复至0.9的时间、拔管时TOFr、PACU停留时间、拔管后低氧血症（SpO₂<90%）的情况并计算拔管时肌松残余（PRNB）发生率,记录首次下床活动时间、术后48 h内镇痛泵总按压次数、有效按压次数、补救镇痛例数、临床肺部感染评分（CPIS）、术后恶心呕吐（PONV）例数、胸管总引流量、胸管留置时间和术后住院时间。
结果：与C组比较,S组PPCs发生率、拔管时PRNB和拔管后低氧血症发生率明显降低,手术结束至拔管时间、给药至TOFr恢复至0.9的时间、PACU停留时间和术后首次下床活动时间明显缩短,拔管时TOFr明显升高,CPIS评分明显降低（P<0.05）;N组手术结束至拔管时间、给药至TOFr恢复至0.9的时间、PACU停留时间明显缩短,拔管时TOFr明显升高,拔管时PRNB发生率明显降低（P<0.05）。与N组比较,S组拔管时PRNB发生率明显降低,手术结束至拔管时间、给药至TOFr恢复至0.9的时间、PACU停留时间和术后首次下床活动时间明显缩短,拔管时TOFr明显升高（P<0.05）。三组其余指标差异均无统计学意义。
结论：舒更葡糖钠在胸腔镜肺切除术后可快速拮抗残余肌松,降低PPCs和拔管时PRNB发生率,促进患者术后快速康复。     

Prevention of postoperative facial edema with steroids after facial surgery

A one-bolus (dose) of 1 g of methylprednisolone was administered intravenously to patients undergoing facial surgery or craniofacial surgery, before the termination of the operative procedure. The degree of facial edema noted was reduced, and when it occurred, it was mild and of shorter duration. These observations were made on the experimental design first, and later in the clinical setting. No adverse effects were noted, and patients given this treatment required less pain medication in the immediate postoperative period. The mechanism of action of the steroids is multifactorial, related to decrease in the accumulation of fluid at the capillary level, and reduction of flow at the venoarterial sphincters. The use of steroids is safe when used with caution in selected patients, and by experienced surgeons.Based on presentation at the seventeenth annual meeting of the American Society for Aesthetic Plastic Surgery, Washington, D.C., March, 1984