重型颅脑创伤并发神经源性肺水肿12例分析

Characteristics of 12 Cases of Severe Craniocerebral Trauma Accompanied with Neurogenic Pulmonary Edema

目的探讨重型颅脑创伤并发神经源性肺水肿(NPE)患者的临床特点和治疗方法。方法回顾性分析我院2001年10月—2009年10月收治的所有颅脑创伤患者812例,依据患者是否并发NPE分为两组,NPE组12例,非NPE组800例。收集所有患者临床资料以及格拉斯格评分(GCS)。结果颅脑创伤患者共812例,其中并发NPE者12例,并发症率为1.48%。两组患者年龄比较,差异无统计学意义(P>0.05);而两组患者性别构成、GCS评分、病死率比较,差异均有统计学意义(P<0.05)。NPE组患者的治疗:去除原发病因,积极降低颅内压,机械通气,早期行气管切开术,氧疗,吗啡,肾上腺糖皮质激素及扩张血管药物等综合治疗。结论重型颅脑创伤并发NPE患者以男性、GCS评分低者高发,病死率高,早期诊断和治疗对改善患者预后尤为重要。

Objective To explore the clinical features of severe craniocerebral trauma accompanied with neurogenic pulmonary edema.Methods We retrospectively analyzed the clinical data of 812 patients with severe craniocerebral trauma （SCT） in our hospital from October.2001 to October.2009.Patients were divided into two groups based on their accompanied disease：Patients with neurogenic pneumonedema （NPE） （n=12;SCT＋NPE group） and patients without neurogenic pneumonedema （n=800;SCT group）Results The incidence of SCT accompanied with NPE in this population was 1.48%.Age was not significantly different between SCT＋NPE group and SCT group （P〉0.05）,while gender,Glasgow Coma Scale （GCS） scores,and mortality were significantly different between these two groups （P〈0.05）.Treatment strategies for patients in SCT＋NPE group included getting rid of the primary disease,decreasing intracranial pressure,mechanical ventilation,early tracheotomy,oxyen therapy,morphine,glucocorticoids,and vasodilators.Conclusion SCT accompanied by NPE mainly occurs in male patients with low GCS scores.The mortality can be high.Early diagnosis and therapy are vital to improve prognosis.