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BMJ：非创伤性ARDS出现巨大纵隔气肿——病例报道

2016-01-26 MedSci MedSci原创

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男性患者，曾患有急性呼吸窘迫综合征现已恢复，接受压力通气支持（压力20 cm H2O，PEEP = 8 cm H2O）。现在患者右侧锁骨上窝出现皮下气肿。

男性患者，曾患有急性呼吸窘迫综合征现已恢复，接受压力通气支持（压力20 cm H2O，PEEP = 8 cm H2O）。现在患者右侧锁骨上窝出现皮下气肿。

胸部CT显示一个巨大的纵隔气肿，而并无气胸的表现（如下图所示），与Macklin效应的表现相符，Macklin效应是指钝性肺泡破裂，空气进入支气管血管鞘，还可进入纵膈（如箭头所示）。尽管Macklin效应通常发生于创伤后，但是有时也可发生于低PEEP值下的机械通气患者。



由于患者并没有出现气胸及纵膈偏移的现象，故采取保守治疗，但是有些病例需要进行胸腔引流和气管切开。

原始出处：

Davide Durí, Amato De Monte, Francesco Toso. Massive pneumomediastinum after non-traumatic ARDS. BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i360 (Published 25 January 2016)Cite this as: BMJ 2016;352:i360.

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    2017-01-07 gaoxiaoe

    #BMJ#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1847883, encodeId=de14184e883ad, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sat Jan 07 20:03:00 CST 2017, time=2017-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025426, encodeId=40872025426c4, content=<a href='/topic/show?id=66f93204223' target=_blank style='color:#2F92EE;'>#创伤性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32042, encryptionId=66f93204223, topicName=创伤性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Sat Jul 02 12:03:00 CST 2016, time=2016-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2040216, encodeId=7c5a2040216f1, content=<a href='/topic/show?id=cb0b1520365' target=_blank style='color:#2F92EE;'>#RDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15203, encryptionId=cb0b1520365, topicName=RDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, createdName=drwjr, createdTime=Wed May 11 00:03:00 CST 2016, time=2016-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335092, encodeId=8fe713350922a, content=<a href='/topic/show?id=e7cc32022c7' target=_blank style='color:#2F92EE;'>#创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32022, encryptionId=e7cc32022c7, topicName=创伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5a2500103, createdName=ms920641618706883, createdTime=Thu Jan 28 10:03:00 CST 2016, time=2016-01-28, status=1, ipAttribution=)]
    2016-07-02 amyloid

    #创伤性#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1847883, encodeId=de14184e883ad, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sat Jan 07 20:03:00 CST 2017, time=2017-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2025426, encodeId=40872025426c4, content=<a href='/topic/show?id=66f93204223' target=_blank style='color:#2F92EE;'>#创伤性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32042, encryptionId=66f93204223, topicName=创伤性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Sat Jul 02 12:03:00 CST 2016, time=2016-07-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2040216, encodeId=7c5a2040216f1, content=<a href='/topic/show?id=cb0b1520365' target=_blank style='color:#2F92EE;'>#RDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15203, encryptionId=cb0b1520365, topicName=RDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08e964, createdName=drwjr, createdTime=Wed May 11 00:03:00 CST 2016, time=2016-05-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335092, encodeId=8fe713350922a, content=<a href='/topic/show?id=e7cc32022c7' target=_blank style='color:#2F92EE;'>#创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32022, encryptionId=e7cc32022c7, topicName=创伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5a2500103, createdName=ms920641618706883, createdTime=Thu Jan 28 10:03:00 CST 2016, time=2016-01-28, status=1, ipAttribution=)]
    2016-05-11 drwjr

    #RDS#

    0

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    2016-01-28 ms920641618706883

    #创伤#

    0

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