上気道閉塞に伴った陰圧性肺水腫例

A case of negative pressure pulmonary edema（NPPE）secondary to postoperative upper airway obstruction

I．はじめに

　頭頸部の手術は術後出血や気道浮腫，上気道閉塞に伴う呼吸困難などさまざまな合併症を生じることがある。今回われわれは，睡眠時無呼吸症候群患者に全身麻酔下で鼻内と咽頭・舌の複合手術を施行し，気管内チューブ抜管直後に上気道閉塞に伴った呼吸困難を生じ，再挿管にも難渋した結果，急性の陰圧性肺水腫を合併した症例を経験したので文献的考察と反省点を加えて報告する。

　There are some cases developed acute postoperative pulmonary complications after combined nasal and pharyngeal surgical procedures. A 37-year-old male with sleep apnea syndrome with nasal obstruction underwent combined surgery. Immediately after postoperative extubation of the endotracheal tube, the patient developed severe airway obstruction. Re-intubation was attempted with a great difficulty, and the airway was finally reestablished by re-intubation after approximately 4 minutes of apnea. Chest X rays demonstrated bilateral diffuse alveolar infiltration, strongly suggesting negative pressure pulmonary edema（NPPE）. Then we immediately started necessary treatments for NPPE and the patient recoverd within 12 hours without any aftereffects. It was pointed out that combined nasal and pharyngeal procedures for obese sleep-apnea patients should be made with great caution. Retrospectively, preoperative cares seemed to be rather insufficient in this particular case.