重型颅脑损伤并发神经源性肺水肿16例临床分析

Clinical Analysis of 16 Cases of Neurogenic Pulmonary Edema Associated with Severe Craniocerebral Injury

目的探讨重型颅脑损伤后并发神经源性肺水肿(neurogenic pulmonary edema,NPE)的发生机制、诊断及治疗。方法回顾性分析我院2000年3月～2010年12月重型颅脑损伤后合并NPE16例的临床诊治资料。结果本组均表现为突发进行性呼吸困难,呼吸频率浅快,嘴唇发绀,呈急性缺氧表现,立即予氧气吸入后症状无明显改善,心率增快、气道内呛咳出大量淡红色泡沫样痰,双肺可闻及广泛湿性啰音。4例再次急诊开颅清除血肿,并去大骨瓣减压;12例予保守治疗。本组存活7例,死亡9例,病死率56.25%。结论 NPE是重型颅脑损伤后患者死亡的主要原因之一,治疗应兼顾肺部及颅脑损伤两方面。早期发现、及时诊断并积极抢救是救治成功的关键。

Objective To explore the pathogenesis and diagnosis and treatment of neurogenic pulmonary edema associated with severe craniocerebral injury.Methods The clinical data of 16 patients of neurogenic pulmonary edema associated with severe craniocerebral injury admitted in our hospital from March 2000 to December 2010 were retrospectively analyzed.Results All the patients presented the mass with sudden progressive dyspneic respiration,shallow and quick breathing rate,lip cyanochroia,and acute oxygen deficiency.But the symptoms were not alleviated after oxygen inhale,combined with increased heart rate,a lot of pink foam sputum coughed from airway,and moist rales were heard in both lungs.4 patients underwent revision hematoma decompressive combined with large craniotomy;12 cases underwent conservative treatment.7 patients survived,and 9 patients（56.25%）died.Conclusion NPE is the main cause of death in patients with severe craniocerebral injury.The treatment should target at both lung and head injuries.Early diagnosis and prompt treatment are critical for the patients.