以胸管成功救治左肺葉塌陷合併縱膈腔偏移之瀕死病患之病例報告

Life-threatening Left Lung Collapse Combined with Mediastinal Shift Rescued by a Chest Tube Insertion —A Case Report

呼吸道出血之病患常因血塊阻塞而造成肺塌陷，嚴重時會影響肺血流之分布而危及病患之血液氣體交換與血行動力學。大範圍的肺塌陷所引起的異常肋膜內負壓也是造成此危象的主因之一。我們在此報告一位呼吸道因出血阻塞導致左肺葉全塌陷及嚴重低血氧之病患，在緊急置入胸管後，立即緩解肋膜負壓而救治成功。我們對此病況相關的致病生理機轉與麻醉處理方式提出討論。吾人認為在處理急症與急救之時，肺血流狀態是需要考慮的。

Pulmonary atelectasis due to acute endobronchial blood clot impaction is not uncommon in the setting of substantial hemoptysis. Sometimes, life-threatening hypoxemia and hemodynamic changes may occur even with collapse of only one lung. Alterations of pulmonary blood flow distribution with increased pulmonary shunt could contribute to these events. In addition, abnormal negative pleural pressure caused by total lung collapse also plays an im-portant role in these situations. Here we report a case with near-fatal left lung collapse was rescued by immediate chest tube insertion. We would like to discuss the relative pathophysiology of the condition and anesthetic man-agement of patient in such a dangerous situation.