自发性食管破裂致顽固性低氧血症术中麻醉管理一例

A case of spontaneous esophageal rupture resulting in refractory hypoxemia during surgery and anesthetic management

患者男,因进食后上腹胀痛、胸痛4 d,于2022年9月26日就诊。胸部CT:提示胸腔积气,慢性支气管炎并肺气肿、肺大疱,双肺炎症。急诊入手术室行胃镜检查+胸腔镜探查手术,术中发生重度低氧血症。经胸部超声排除心力衰竭、肺不张、肺栓塞等疾病的基础上,确诊为重度急性呼吸窘迫综合征(ARDS)。手术过程中实施肺保护性通气策略,精细麻醉管理,手术顺利完成。

Male patient,presented with upper abdominal distension and chest pain for 4 days after eating,and sought medical attention on September 26,2022.Chest CT revealed pneumothorax,chronic bronchitis combined with emphysema,bullae in lungs,and bilateral pneumonia.The patient was urgently taken to the operating room for gastroscopy+thoracoscopic exploration operation.Severe hypoxemia occurred during the surgery.After excluding heart failure,atelectasis,and pulmonary embolism through chest ultrasound,the patient was diagnosed with severe acute respiratory distress syndrome(ARDS).Lung-protective ventilation strategies were implemented during the surgery,along with meticulous anesthesia management.The operation was successfully completed.