全身痲醉後發生氣縱隔及皮下氣腫並呈現閉塞性鼻音之病例報告

Subcutaneous Emphysema Associated with Pneumomediastinum after General Anesthesia—Closed Rhinolalia as an Initial Presentation in One of Two Cases

本文報告兩個於全身麻醉後發生氣縱隔及皮下氣腫的病例。其中一例在早期有明顯鼻音，至於一般的症狀，包括胸痛或呼吸急促等反而未見。雖然兩位病患之胸部電腦斷層掃描並沒有發現血管周邊氣腫，但仍須高度懷疑為肺泡破裂併行Macklineffect而造成麻醉後氣縱隔及皮下氣腫。由於並無証據顯示有氣管破裂之現象，也沒有其它併發症，故以觀察為最好之治療方式。本文亦對相關各種鑑別診斷及處理方法加以討論。

We report two cases of subcutaneous emphysema associated with pneumomediastinum after general anesthesia. One of them was devoid of common symptoms such as chest pain and dyspnea, but significant closed rhinolalia was noted initially. Though in these two cases the chest CT scanning revealed no perivascular emphysema, we highly suspected that this phenomanum resulted from alveolar rupture with Macklin effect. Close observation was the best treatment since neither trachea injury was in evidence nor was there the occurrence of other complication. The differential diagnosis and approach to therapy are presented after review of the relevant literature.