PDF(Pubmed)
Abstract：
Contralateral tension pneumothorax is a rare but fatal complication of one-lung ventilation. The life-saving decompression of pleural space was frequently delayed by the difficult confirmation of diagnosis because of general anesthesia that masks specific clinical presentations when the patient is alert. We reported a case of tension pneumothorax in a patient who underwent thoracic spine instrumentation. There were no contralateral tension pneumothorax cases on file from the search of the Anesthesia Quality Institute Closed Claims Database from 2001 to 2017. We systematically searched PubMed, Ovid MEDLINE, Embase, and Google Scholar. Over the past 30 years, there were 21 single case reports and two case series were retrieved. It was a consensus that difficult confirmation of the diagnosis of contralateral tension pneumothorax is the culprit of delayed life-saving intervention. Difficulty of oxygenation with increasing inspiratory pressure was usually the first sign suggesting contralateral pneumothorax; however, earlier presentations of cardiovascular system failure than respiratory failure have significantly increased the incidence of cardiac arrest and death. It is paramount to maintain a high suspicion of tension pneumothorax. The application of esophageal stethoscope, lung ultrasound, and simulator training may improve the chance of early diagnosis and patient outcome.
摘要：
对侧张力性气胸是单肺通气的罕见但致命的并发症。由于全身麻醉掩盖了患者警觉时的特定临床表现，难以确认诊断，因此难以挽救胸膜腔的生命减压常常被延迟。我们报告了一例接受胸椎器械治疗的患者的张力性气胸。从2001年至2017年，在麻醉质量研究所封闭索赔数据库的搜索中，没有对侧张力性气胸病例。我们系统地搜索了PubMed,OvidMEDLINE,Embase,谷歌学者。在过去的30年里,有21例单病例报告和两个病例系列被检索。人们一致认为，难以确认对侧张力性气胸的诊断是延迟挽救生命干预的罪魁祸首。随着吸气压力的增加，氧合困难通常是提示对侧气胸的第一个迹象；然而，较早出现心血管系统衰竭比呼吸衰竭有显著增加心脏骤停和死亡的发生率.保持对张力性气胸的高度怀疑是至关重要的。食管听诊器的应用,肺超声,和模拟器训练可以提高早期诊断的机会和病人的结果。
