以俯臥姿勢進行腰椎手術中發生因血塊造成之 急性呼吸道阻塞——病例報告

Unexpected Blood Clot-induced Acute Airway Obstruction in a Patient with Inactive Pulmonary Tuberculosis during Lumbar Spine Surgery in the Prone Position —A Case Report

任何時候若發生呼吸道阻塞都有致命的可能，因此必須立即確認並處理。我們報告首例咳血病人因姿勢變換造成的急性呼吸道阻塞，我們以各種方式處理5直到病人由俯臥翻回平躺姿勢才得以緩解。於是我們分析發生這個事件的原因，以及麻醉中對於此種呼吸道阻塞的處理方式與原則。

Airway obstruction is always a life-threatening event, and it must be recognized and managed immediately. We report an instance of acute airway obstruction associated with hemoptysis in an elderly patient with inactive advanced pulmonary tuberculosis (TB) while undergoing spine surgery. Airway obstruction was highly suspected in consequence of postural change because immediate resolution was rewarded after reversion of the position from prone to supine. The chest surgeon consulted intraoperatively did a fiberoptic bronchoscopy and found that the blood was mainly surging from the branching bronchus of right lower lobe, and thus the source of bleeding was confirmed. Hence, in this presentation we discuss the contributory factors which led to the occurrence of hemop-tysis and the appropriate perioperative management of this kind of airway obstruction.