縱膈瘤之孕婦經麻醉誘導後氣道完全阻塞之病例報告

Total Airway Occlusion in a Parturient with a Mediastinal Mass after Anesthetic induction-- A Case Report

26歲孕婦至本院行34週產檢，當時她已持續2個月出現乾咳、呼吸困難、端坐呼吸的症狀，身體檢查與超音波顯示她的頸部出現大量淋巴結，經醫師會商之後，決定首先娩出嬰兒。麻醉誘導以後，支氣管鏡顯示其下呼吸道完全阻塞並可見支氣管黏膜水腫，立即給予高通氣壓力、高劑量的固醇類藥物及支氣管擴張劑，但高呼吸道壓力未緩解，血氧飽和濃度仍持續下降。幸運的是當我們改變了患者姿勢後，重建了其呼吸道通氣情形並使血氧飽和濃度由40％回升至100％。此次手術順利的娩出健康嬰兒，同時診斷為惡性淋巴癌。在此病例中，半坐臥姿勢及藥物重建了其呼吸道通氣。目前她仍在本院接受化療及追蹤。

A 26-year-old primigravida having suffered from dry cough, dyspnea and orthopnea for two months came to our hospital for a check up at 34 weeks gestation. Physical examination and ultrasonic study showed a lot of lymph nodes around her neck. After close coordination of opinion from responsible doctors, it was decided to deliver the baby first. After anesthetic induction, bronchoscopy revealed that the lower trachea was totally collapsed with obvious tracheobronchial mucosal swelling. A high inspiratory pressure was applied, and high-dose corticosteroid and bronchodilator were immediately given, but the airway resistance was still high and her SpO2 level was falling down. Fortunately, after we changed the patient's position from supine to semi-sitting, ease of ventilation was reestablished and SpO2 rose up from 40% to 100%. We then delivered a healthy baby, and malignant lymphoma was proven by biopsy of the cervical lymph nodes performed immediately after delivery. In this case, the change to semi-sitting position and relevant medication helped reestablish her ventilation and save her life. At the moment we write she is undergoing chemotherapy and does her follow-up at our hospital as advised.