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NEJM:警惕胸腔穿刺术后复张性肺水肿并发症

2014-08-01 MedSci MedSci原创

患者,男,67岁,患有晚期酒精性肝硬化,因渐进性呼吸困难入院治疗。胸片显示右侧胸腔有大量积液(A图)。因怀疑为肝性胸水,对其进行 胸腔穿刺术,抽取渗出液1500ml。  A图 4小时后出现咳嗽、呼吸急促、心动过速症状,听诊右肺湿罗音。氧饱和度为82%。胸部CT显示右肺散在实变影及磨玻璃样阴影(B图),表明为复张性肺水肿。   B图 患者接受利尿剂治疗及

患者,男,67岁,患有晚期酒精性肝硬化,因渐进性呼吸困难入院治疗。

胸片显示右侧胸腔有大量积液(A图)。因怀疑为肝性胸水,对其进行 胸腔穿刺术,抽取渗出液1500ml。

 

A图


4小时后出现咳嗽、呼吸急促、心动过速症状,听诊右肺湿罗音。氧饱和度为82%。胸部CT显示右肺散在实变影及磨玻璃样阴影(B图),表明为复张性肺水肿。

 

B图


患者接受利尿剂治疗及通过呼吸面罩进行高流量氧疗,病情逐渐得到改善。4天后, CT发现完全缓解的影响学表现(图C)。


C图


复张性肺水肿可能为胸腔穿刺并发症。治疗方案大部分是有效的。该类情况的危险因素包括年龄小,长期肺不张及快速肺复张。

原始出处:

Perricone G, Mazzarelli C.Images in clinical medicine. Reexpansion pulmonary edema after thoracentesis.N Engl J Med. 2014 Mar 20;370(12):e19. doi: 10.1056/NEJMicm1309844.

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    2016-09-13 邓启付

    和普通大量胸腔积液行胸腔闭式引流一样,肯定有规定,一次引流量和速度有控制,不然会引起复张性肺水肿。

    0

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    2016-08-30 1771ae4158m

    好东西

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=125810, encodeId=ac0d125810f4, content=和普通大量胸腔积液行胸腔闭式引流一样,肯定有规定,一次引流量和速度有控制,不然会引起复张性肺水肿。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Tue Sep 13 22:47:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107721, encodeId=e05f10e721c3, content=好东西, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Aug 30 22:04:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107722, encodeId=f27d10e7229e, content=好东西,学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Aug 30 22:04:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1952797, encodeId=a90f1952e97aa, content=<a href='/topic/show?id=ac8f841615a' target=_blank style='color:#2F92EE;'>#胸腔穿刺术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84161, encryptionId=ac8f841615a, topicName=胸腔穿刺术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=65c7309, createdName=fengxx, createdTime=Wed Dec 31 10:57:00 CST 2014, time=2014-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757625, encodeId=140d1e576256b, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Tue Mar 17 03:57:00 CST 2015, time=2015-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311860, encodeId=def913118603a, content=<a href='/topic/show?id=21a6e54280e' target=_blank style='color:#2F92EE;'>#穿刺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75428, encryptionId=21a6e54280e, topicName=穿刺)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b48400, createdName=rgjl, createdTime=Sun Aug 03 12:57:00 CST 2014, time=2014-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333324, encodeId=45db133332419, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Sun Aug 03 12:57:00 CST 2014, time=2014-08-03, status=1, ipAttribution=)]
    2016-08-30 1771ae4158m

    好东西,学习一下

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=125810, encodeId=ac0d125810f4, content=和普通大量胸腔积液行胸腔闭式引流一样,肯定有规定,一次引流量和速度有控制,不然会引起复张性肺水肿。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Tue Sep 13 22:47:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107721, encodeId=e05f10e721c3, content=好东西, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Aug 30 22:04:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107722, encodeId=f27d10e7229e, content=好东西,学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Aug 30 22:04:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1952797, encodeId=a90f1952e97aa, content=<a href='/topic/show?id=ac8f841615a' target=_blank style='color:#2F92EE;'>#胸腔穿刺术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84161, encryptionId=ac8f841615a, topicName=胸腔穿刺术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=65c7309, createdName=fengxx, createdTime=Wed Dec 31 10:57:00 CST 2014, time=2014-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757625, encodeId=140d1e576256b, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Tue Mar 17 03:57:00 CST 2015, time=2015-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311860, encodeId=def913118603a, content=<a href='/topic/show?id=21a6e54280e' target=_blank style='color:#2F92EE;'>#穿刺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75428, encryptionId=21a6e54280e, topicName=穿刺)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b48400, createdName=rgjl, createdTime=Sun Aug 03 12:57:00 CST 2014, time=2014-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333324, encodeId=45db133332419, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Sun Aug 03 12:57:00 CST 2014, time=2014-08-03, status=1, ipAttribution=)]
    2015-03-17 丁鹏鹏
  6. [GetPortalCommentsPageByObjectIdResponse(id=125810, encodeId=ac0d125810f4, content=和普通大量胸腔积液行胸腔闭式引流一样,肯定有规定,一次引流量和速度有控制,不然会引起复张性肺水肿。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzcjoLTEEgkSSQ8pVIiaf4a4INaoMLBV16QEk3dvvBRpicwIwmDGv0jePErJ4aE9ibVBDPtkialQLT9Bs/0, createdBy=04811949400, createdName=邓启付, createdTime=Tue Sep 13 22:47:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107721, encodeId=e05f10e721c3, content=好东西, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Aug 30 22:04:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=107722, encodeId=f27d10e7229e, content=好东西,学习一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Tue Aug 30 22:04:00 CST 2016, time=2016-08-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1952797, encodeId=a90f1952e97aa, content=<a href='/topic/show?id=ac8f841615a' target=_blank style='color:#2F92EE;'>#胸腔穿刺术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84161, encryptionId=ac8f841615a, topicName=胸腔穿刺术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=65c7309, createdName=fengxx, createdTime=Wed Dec 31 10:57:00 CST 2014, time=2014-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1757625, encodeId=140d1e576256b, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Tue Mar 17 03:57:00 CST 2015, time=2015-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1311860, encodeId=def913118603a, content=<a href='/topic/show?id=21a6e54280e' target=_blank style='color:#2F92EE;'>#穿刺#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75428, encryptionId=21a6e54280e, topicName=穿刺)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b48400, createdName=rgjl, createdTime=Sun Aug 03 12:57:00 CST 2014, time=2014-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333324, encodeId=45db133332419, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Sun Aug 03 12:57:00 CST 2014, time=2014-08-03, status=1, ipAttribution=)]
    2014-08-03 rgjl
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    2014-08-03 小华子

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