新医学
新醫學
신의학
NEW CHINESE MEDICINE
2014年
2期
134-137
,共4页
颅脑损伤%神经源性肺水肿%治疗
顱腦損傷%神經源性肺水腫%治療
로뇌손상%신경원성폐수종%치료
Brain damage%Neurological pulmonary edema%Treatment
目的：分析神经源性肺水肿（NPE）的诊断及治疗要点。方法分析27例重型颅脑损伤并发NPE患者的临床表现、实验室及辅助检查、治疗方法及预后等。结果27例患者入院后及时完善相关检查并及早明确NPE诊断。所有患者均出现进行性呼吸困难，气道内有大量淡红或粉红色泡沫痰；PaO2均＜60 mm Hg；胸部X线片及CT检查均可见阴影或渗出；颅脑CT检查均可见血肿或出血灶。明确诊断后立即进行抢救，严密监测患者生命体征、痰液痰量、心输出量等，动态监测血气，定时复查胸部X线片。5例采用内科保守治疗，主要为减轻脑水肿、预防脑血管痉挛、营养脑神经、预防继发性癫痫发作及预防感染等，疗程1～3周。22例采用外科手术治疗，术后再行上述内科治疗。经治疗后，13例（48％）患者好转，于住院后1．5～2个月出院，出院时一般情况均稳定。14例（52％）死亡，死于再发脑出血9例、并发肺部感染5例。结论早诊断早治疗对NPE患者有益，在兼顾颅内病变和肺水肿的同时应积极抗感染，防治并发症。
目的：分析神經源性肺水腫（NPE）的診斷及治療要點。方法分析27例重型顱腦損傷併髮NPE患者的臨床錶現、實驗室及輔助檢查、治療方法及預後等。結果27例患者入院後及時完善相關檢查併及早明確NPE診斷。所有患者均齣現進行性呼吸睏難，氣道內有大量淡紅或粉紅色泡沫痰；PaO2均＜60 mm Hg；胸部X線片及CT檢查均可見陰影或滲齣；顱腦CT檢查均可見血腫或齣血竈。明確診斷後立即進行搶救，嚴密鑑測患者生命體徵、痰液痰量、心輸齣量等，動態鑑測血氣，定時複查胸部X線片。5例採用內科保守治療，主要為減輕腦水腫、預防腦血管痙攣、營養腦神經、預防繼髮性癲癇髮作及預防感染等，療程1～3週。22例採用外科手術治療，術後再行上述內科治療。經治療後，13例（48％）患者好轉，于住院後1．5～2箇月齣院，齣院時一般情況均穩定。14例（52％）死亡，死于再髮腦齣血9例、併髮肺部感染5例。結論早診斷早治療對NPE患者有益，在兼顧顱內病變和肺水腫的同時應積極抗感染，防治併髮癥。
목적：분석신경원성폐수종（NPE）적진단급치료요점。방법분석27례중형로뇌손상병발NPE환자적림상표현、실험실급보조검사、치료방법급예후등。결과27례환자입원후급시완선상관검사병급조명학NPE진단。소유환자균출현진행성호흡곤난，기도내유대량담홍혹분홍색포말담；PaO2균＜60 mm Hg；흉부X선편급CT검사균가견음영혹삼출；로뇌CT검사균가견혈종혹출혈조。명학진단후립즉진행창구，엄밀감측환자생명체정、담액담량、심수출량등，동태감측혈기，정시복사흉부X선편。5례채용내과보수치료，주요위감경뇌수종、예방뇌혈관경련、영양뇌신경、예방계발성전간발작급예방감염등，료정1～3주。22례채용외과수술치료，술후재행상술내과치료。경치료후，13례（48％）환자호전，우주원후1．5～2개월출원，출원시일반정황균은정。14례（52％）사망，사우재발뇌출혈9례、병발폐부감염5례。결론조진단조치료대NPE환자유익，재겸고로내병변화폐수종적동시응적겁항감염，방치병발증。
Objective To analyze the clinical characteristics and treatment of neurological pulmonary edema (NPE).Methods Clinical data of 27 cases of serious brain damage complicated with NPE were ana-lyzed,including their clinical features,treatment and prognosis.Results Relevant inspections were finished and NPE diagnosis was confirmed immediately in 27 patients after hospitalization.All cases had progressive dyspnea,with great amount of pale red or pink frothy sputum in there airway;PaO2 <60 mm Hg.Chest X ray and CT examination showed shadows or leakage.Craniocerebral CT examination showed hematoma or bleeding. All patients were treated immediately after diagnosis.Their vital signs,sputum volume,cardiac output and blood gas analysis were closely monitored,chest X ray reviewed regularly.Five patients received medical treat-ment of 1 ~3 weeks,including relieving cerebral edema,cranial nerve nutrition,preventing cerebral vasospasm and secondary epilepsy seizures,together with infection control.Twenty-two patients received surgical treatment in addition of the above management.After treatment,thirteen patients (48%)were rescued and discharged after 1 .5-2 months.Fourteen patients died of recurrent cerebral hemorrhage or pulmonary infection.Conclu-sion Early diagnosis and treatment are beneficial for NPE patients.Intracranial lesions and pulmonary edema should be controlled at the same time,as well as preventions of infection and other complications.
