顯微手術後因使用低分子量Dextran而使負壓性肺水腫延遲鍰解 病例報告

Delayed Resolution of Negative Pressure Pulmonary Edema Associated with Low-molecular-weight Dextran after Microsurgery — A Case Report

負壓性肺水腫是在麻醉誘導或呼吸窘迫下可能發生的罕見上呼吸道阻塞併發症，此類肺水腫形成的主要病理原因是由於突發顯著的肋膜間壓與閉鎖的會厭相互拮抗下，進而破壞了肺泡血管的完整性與正常的Starling機制，最終導致血管通透性增加，血管內液體滲出至肺間質中所形成。以往的醫學報告，此類負壓性肺水腫的病人經過妥善治療處理，絕大部分均可在二十四小時內緩解。在此，我們提出了一個在接受拇指顯微縫合手術後發生負壓性肺水腫與延遲緩解的病例報告，並討論負壓性肺水腫的其他可能病理機轉、也探討此病例中臨床病徵的延遲緩解與使用dextran之間可能的關係。

Negative pressure pulmonary edema (NPPE) is an uncommon perioperative complication after total or partial upper airway obstruction during anesthesia or respiratory distress. The cardinal event causative of the pathophysiology is believed to be the generation of a sudden and marked negative intrapleural pressure against a closed glottis, resulting in a disruption of the normal intravascular Starling mechanism. Ultimately, excessive intra- vascular fluid which transudes into the interstitial space eventuates in pulmonary edema. In most reports, patients suffering from NPPE could recover within 24 h after appropriate treatment. Here, we report a case of highly suspected NPPE with delayed resolution associated with the perioperative use of dextran, following microsurgery for digital anastomosis of the nearly amputated right thumb. We have reviewed the possible pathomechanisms of NPPE, and discuss herein the possible relationship between the delayed resolution of NPPE and perioperative use of dextran.