中心静脉压降低型急性心源性肺水肿的临床研究  

The clinical investigation of acute cardiogenic pulmonary edema with lower central venous pressure

作　　者：朱蕾[1] 连宁芳[2] 王齐兵[3] 钮善福[1] 

机构地区：[1]复旦大学附属中山医院肺科,上海200032 [2]福建医科大学附属一院呼吸科 [3]复旦大学附属中山医院心内科

出　　处：《中国呼吸与危重监护杂志》2006年第1期10-12,共3页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨中心静脉压（CVP）降低型急性心源性肺水肿（ACPE）患者的临床特点和治疗方法。方法回顾性分析CVP降低型ACPE的临床资料。结果4例ACPE患者的CVP下降至1—4cmH2O，其特点是出现明显的呼吸增强、增快，表现为呼吸频率〉35次／min、三凹征和呼吸性碱中毒。2例分别经过以利尿剂为主的药物治疗和经面罩机械通气治疗后，心功能和肺水肿迅速改善，CVP恢复正常。2例大量补液治疗后，肺水肿加重，CVP仍在较低水平，最终因心源性休克死亡。结论部分ACPE患者因呼吸运动代偿性过度增强、胸腔负压增加，CVP不升反降；以利尿剂为主的药物治疗或机械通气治疗可缓解病情，使CVP恢复正常。Objective To analyze the clinical characteristics and treatment of acute cardiogenic pulmonary edema（ACPE） with lower central venous pressure（CVP）. Methods The clinical characteristics and treatment of ACPE with lower CVP were analyzed retrospectively. Results 4 ACPE patients had decreased CVP from 1 to 4 cm H2O. All of these four subjects had compensative respiration reinforcement. The respiration rates were all above 35 times per minute with three depressions sign and respiratory alkalosis. 2 cases recovered through diuretic therapy or face mask mechanical ventilation（MV）, then the CVP returned to normal, 2 patients progressively deteriorated and died after large volume fliud supplement and the CVP remained at lower level. Conclusions In some cases of ACPE, the respiratory movement was reinforced markedly because of compensation which resulted in a deceased CVP. The diuretic therapy or MV might improve cardiac function and pulmonary edema rapidly.

关 键 词：急性心源性肺水肿 中心静脉压 利尿剂 机械通气 

分 类 号：R541.63[医药卫生—心血管疾病] R654.2[医药卫生—内科学]