神经源性肺水肿6例临床分析及文献复习  

Clinical analysis and literature review of six cases of neurogenic pulmonary edema

作　　者：陆宏达[1] 姜素文[1] 吴霄迪[1] 尹彦斌[1] 高文卿[2] Lu Hongda;Jiang Suwen;Wu Xiaodi;Yin Yanbin;Gao Wenqing(Department of Emergency,the Third Central Hospital of Tianjin,Tianjin 300170,China;Heart Center,the Third Central Hospital of Tianjin,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院急诊科,天津300170 [2]天津市第三中心医院心脏中心,天津300170

出　　处：《中华危重病急救医学》2022年第2期188-190,共3页Chinese Critical Care Medicine

基　　金：天津市医院协会医院管理研究项目(2016004)。

摘　　要：目的探讨神经源性肺水肿(NPE)早期诊断及正确治疗并复习文献。方法回顾分析天津市第三中心医院急诊科2017年3月至2021年3月收治的6例急诊诊断为NPE患者病例资料。结果6例患者均起病急,出现严重的呼吸困难及低氧血症,双肺可闻及明显的湿性啰音,白细胞计数(WBC)均不同程度升高(11~22)×109/L,降钙素原(PCT)正常或轻度升高,痰细菌学检查均为阴性,氧合指数均<200 mmHg(1 mmHg≈0.133 kPa);胸部CT主要表现为斑片或大片状渗出,病灶大小不一,不按叶段分布。通过降低颅内压、呼吸机辅助呼吸、液体治疗、抗菌药物抗感染治疗、营养支持等,6例患者均好转出院,无一例因NPE而死亡。结论NPE病情复杂,发病急,发展迅速,早期诊断、采取正确的治疗措施,可以提高救治成功率,改善患者预后。Objective To explore the early diagnosis and correct treatment of neurogenic pulmonary edema(NPE)and review the literature.Method Retrospective analysis was performed in six patients diagnosed as NPE who were admitted to the emergency department of Tianjin Third Central Hospital from March 2017 to March 2021.Results Six patients had acute onset,presenting severe dyspnea and hypoxemia,and obvious wet rales could be heard in both lungs.The white blood cell count(WBC)increased to varying degrees(11-22)×109/L,procalcitonin(PCT)was normal,or slightly increased,sputum bacteriological examination was negative,and oxygenation index was<200 mmHg(1 mmHg≈0.133 kPa).Chest CT mainly showed patchy or patchy exudation.The lesions were of different sizes and were not distributed according to lobes.By reducing intracranial pressure,ventilator assisted breathing,liquid therapy,anti-infection therapy with antibiotics,nutritional support,all six patients were well and discharged,and no one died of NPE.Conclusions NPE has complex condition,acute onset and rapid development.Early diagnosis and correct treatment can improve the success rate of treatment and prognosis of patients with NPE.

关 键 词：神经源性肺水肿 诊断 治疗 文献复习 

分 类 号：R563[医药卫生—呼吸系统] R741[医药卫生—内科学]