Mendelssohn's syndrome

Description:

Hit of gastric contents in respiratory tracts leads to severe damage of lungs - to development of aspiratsiopny pneumonia, a so-called syndrome of Mendelssohn [Mendelson E., 1946]. Most often it meets at razyolichny, first of all bryushnopolostny, operations and at childbirth. From 11 to 14% of the lethal outcomes connected with an anesthesia are caused by development of an aspiration syndrome. Among all cases of maternal mortality the last in 2% of cases yavlyayotsya by its reason and if the general anesthesia is used at opeyorativny rodorazreshepiya, its specific weight increases up to 15 - 52%.

Symptoms of the Syndrome of Mendelssohn:

The clinic, At hit of gastric contents develops in dykhayotelny ways a picture of the heavy respiratory nedoyostatochnost which is characterized by a bronchospasm, cyanosis, ди­спноэ, tachycardia and the accruing fluid lungs. Sometimes nayochalny changes are so sharply expressed that there can come the cardiac standstill. If the patient survives, nayorusheniye of the general and pulmonary blood-groove come to light, progresyosiruyushchy arterial hypotonia with reduction of cordial emission develops. Owing to the expressed giioksemiya leyogochny vascular resistance increases and pressure increases in a leyogochny artery. Disturbances of fabric perfusion can lead to development of a metabolic acidosis in combination with a respiratoryony alkalosis.

Expressiveness of clinical changes at aspiration pneumonia and weight of pathophysiological disturbances are connected with prevalence of defeat of pulmonary fabric. Sometimes the kliyonichesky picture has more erased character, and funktsionalyyony shifts are shown less. However, as the most expressed morphological changes in lungs occur in 24-48 h after aspiration, signs of a respiratory nedostayotochnost can progress and be shown in the most tyazheyoly form only on second day from the moment of emergence of this complication.

Reasons of the Syndrome of Mendelssohn:

In an etiology of aspiration pneumonia the role of high acidity of gastric contents is accurately established. The most expressed changes in lungs develop at aspiration of the liquid having рН lower than 2,5. At higher рН an aspiyorata of change in lungs are less expressed and have passing character. Has value and quantity aspirirovanny soderyozhimy which has to make 0,3-0,4 ml/kg of body weight, or more than 25 ml, and also existence in it is mute parts of food and other impurity which also injure lungs.

Treatment of the Syndrome of Mendelssohn:

Treatment of a syndrome of Mendelssohn includes measures, napravlenyony on stopping of acute respiratory insufficiency and a proyofilaktika of infectious complications. If to eliminate an arteriyoalny anoxemia in the conditions of spontaneous breath not удает­ся, use artificial ventilation of the lungs under the alternating positive pressure. In the most hard cases she will be seen within several days to improvement at the patient of indicators of pulmonary gas exchange. Instructions on efficiency of use of giperbaricheyosky oxygenation Imeyotsya. Medicamentous therapy includes use of high doses of corticosteroids and antiyobiotik, and also symptomatic means. Local endotracheal instillations of solution of hydrosodium carbonate and steroids do not prevent development of aspiration pneumonia.

Forecast. A lethality at Mendelssohn's syndrome - from 30 to 60%. At the patient who transferred an aspiration acid pnevyomoniya disturbances of pulmonary function can not be noted further or the expressed obstructive or restrictive disturbances develop in various degree.