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…     

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     

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。     

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…     

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.     

复张性肺水肿的诊断与防治分析

复张性肺水肿（RPE）是继发于各种原因所致的肺不张之后，在肺迅速复张时或复张后发生的急性肺水肿，多见于气胸手术治疗后，肺被压缩的时间越长，其发生的机率越高。现就1993-2003年10年间我院诊治的12例RPE患者临床资料总结如下。     

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.     

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。     

The risk for re-expansion pulmonary edema following spontaneous pneumothorax

Purpose

Re-expansion pulmonary edema is an uncommon condition that occurs when a collapsed lung is expanded. The aim of the present study was to investigate the incidence and risk factors associated with re-expansion pulmonary edema which may occur as a complication when carrying out treatment for spontaneous pneumothorax.

Methods

A total of 462 patients with spontaneous pneumothorax treated with chest tube drainage in inpatient settings at the Nissan Tamagawa Hospital during the 6-year period between January 2007 and December 2012 were retrospectively evaluated. The data were analyzed to identify any clinical differences between the patients with and without re-expansion pulmonary edema.

Results

Re-expansion pulmonary edema occurred on 30 (6.5 %) of the 462 patients. The duration of lung collapse in the patients with re-expansion pulmonary edema was longer than that observed in the patients without re-expansion pulmonary edema. (7.7 ± 9.1 and 2.4 ± 4.6 days). This difference was statistically significant (P < 0.0001). The extent of lung collapse in the patients with re-expansion pulmonary edema was more severe than that observed in the patients without re-expansion pulmonary edema. This difference was also statistically significant (P = 0.004).

Conclusions

The results suggest that treating spontaneous pneumothorax using chest tube drainage requires careful consideration in view of the relatively high incidence of re-expansion pulmonary edema, especially in cases associated with long periods of lung collapse or large spontaneous pneumothoraxes.     

Postoperative re-expansion causing unilateral pulmonary edema]

A case of re-expansion pulmonary oedema is reported. A 7-year-old girl, after having been operated on for a lung tumour, had a postoperative haemothorax combined with atelectasis of the left upper lobe. After she had recovered from the first dose of chemotherapy, the thoracotomy wound was reopened to remove the partially organised and lysed haemothorax, as well as the very thickened pleura. The patient developed clinical signs of pulmonary oedema very shortly after the end of the anaesthetic (tachypnoea, cyanosis, a decrease in oxygen saturation when FIO2 < 1, pink frothy secretions in the endotracheal tube). End-inspiratory crepitations became audible in the left lung field only. The chest film showed left-sided diffuse nodular alveolar opacities. The girl was again ventilated, with + 5 cmH2O positive end-expiratory pressure. She was extubated 36 h later, and discharged a few days later without any sequela. This case was the first to be described in a child after pleural surgery. The death rate, estimated from a literature survey, is about 20%.     

Bilateral re-expansion pulmonary edema in a child: a reminder

Re-expansion pulmonary edema (RPE) is an uncommon complication of sudden reinflation of a lung collapsed by pneumothorax or pleural effusion. We present a case of bilateral pulmonary edema following unilateral drainage of a pleural effusion in a young child with non-Hodgkin's lymphoma.     

Ipsilateral re-expansion pulmonary edema in a neurosurgical patient--a case report

We report a case of a 42-year-old female with right parietal glioma, scheduled for elective craniotomy and tumor excision. The patient developed pneumothorax in the postoperative period. An incidence of unilateral pulmonary edema occurring as a result of rapid re-expansion of collapsed lungs is described. This type of pulmonary edema may delay postoperative recovery and have a catastrophic course especially in neurosurgical patients.     

Chylothorax and re-expansion pulmonary edema following myocardial re-vascularization: role of lymph vessel insufficiency

Chylothorax is a rare complication following coronary artery bypass graft surgery. In the following case, we report a chylothorax complicating left internal mammary artery harvesting due to injury of the left anterior mediastinal lymph node chain (LAMLNC) at the level of the proximal pedicle of the mammary artery. Re-expansion pulmonary edema occurred during re-operation for chylothorax following suturing of this lymph node chain. This observation demonstrates the role of the LAMLNC in both complications when injured or interrupted.     

Independent pulmonary ventilation as a treatment in the re-expansion of atelectasis

Two patients with respiratory failure were treated with independent lung ventilation (ILV). During their clinical course they developed atelectasis without response to usual therapies. The use of ILV and selective positive end-expiratory pressure (S-PEEP) allowed lung expansion and oxymetric improvement. With the ILV plus S-PEEP we tried to correct the abnormal ventilation/perfusion ratio. ILV plus S-PEEP increases both the ventilation in the highly perfused areas, and the functional residual capacity selectively in the pathologic lung in unilateral affection cases.