摘要
围手术期发生的寂静肺具有起病急、进展迅速及死亡率高等特点。本文报道1例62岁左下肺结节患者在胸腔镜下接受下肺段切除术,手术中使用罗库溴铵辅助气管插管。首次给药后21 min,患者出现气道压增高、通气困难及“铁肺”手感,表现出类似于寂静肺的症状。随后追加静脉注射甲泼尼龙80 mg和肾上腺素50μg(分次),但未见明显缓解,血氧饱和度降至38%,再次给予肾上腺素1 mg后,气道压逐渐降至33 cmH_(2)O,血氧饱和度也逐步回升。考虑到气道痉挛可能由多次插管刺激引起,再次追加罗库溴铵以便进行再插管,然而插管前患者再次出现气道压增高与通气困难。对本次不良事件与可疑药物罗库溴铵进行关联性评价,结果为可能有关。本文对罗库溴铵引发寂静肺的机制、相应的预防与救治进行了探讨,提示术前应进行充分的麻醉评估,制定适宜的麻醉诱导方案,一旦发生不良事件,应及时识别救治。
The silent lung that occurs during the perioperative period is characterized by rapid onset,rapid progression,and high mortality.This article reports a case of a 62-yearold patient with a left lower lung nodule who underwent lower lung segmentectomy under thoracoscopy and was assisted with tracheal intubation using rocuronium.21 minutes after the first administration,the patient presented with increased airway pressure,difficult ventilation,a"steel lung"feel,and symptoms similar to silent lung.Subsequently,80 mg of methylprednisolone and 50μg of epinephrine(in divided doses)were injected intravenously,but no relief was observed,and the blood oxygen saturation decreased to 38%.In this case,after giving another 1 mg of epinephrine,the airway pressure gradually decreased to 33 cmH_(2)O,and the blood oxygen saturation gradually increased.Considering that airway spasm might be caused by multiple intubation stimulations,additional rocuronium bromide was added to allow for reintubation.However,the patient again experienced increased airway pressure and difficulty in ventilation prior to intubation.The clinical pharmacist conducted a correlation evaluation of this adverse event and considered the result as possible.The mechanism,rescue and prevention of silent lung induced by rocuronium was also discussed in the case report.A thorough anesthesia assessment should be conducted prior to surgery,and an appropriate anesthesia induction plan should be formulated.Once an adverse event occurs,it should be promptly identified and treated.
作者
高茜倩
徐娜
沈江华
曾艳
GAO Qianqian;XU Na;SHEN Jianghua;ZENG Yan(Department of Pharmacy,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Surgical Anesthesiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《药物流行病学杂志》
CAS
2024年第11期1320-1324,共5页
Chinese Journal of Pharmacoepidemiology
关键词
罗库溴铵
气道痉挛
寂静肺
药品不良反应
Rocuronium bromide
Airway spasm
Silent lung
Adverse drug reaction
作者简介
通信作者:曾艳,硕士,主任药师,副教授,Email:zengyan@xwhosp.org。
