脉搏指示连续心排血量监测技术在神经源性肺水肿诊治中的应用价值：附4例报道并文献复习

The application value of pulse induced contour cardiac output monitoring in diagnosis and treatment of neurogenic pulmonary edema： a report of 4 cases and review of literature

目的探讨脉搏指示连续心排血量（PiCCO）监测技术在神经源性肺水肿（NPE）患者诊治中的应用价值。方法回顾性分析皖南医学院附属黄山市人民医院重症医学科2011年至2013年4例重症神经系统疾病并发NPE患者的PiCCO血流动力学特点及诊治经过，并结合文献进行分析讨论。结果4例NPE患者PiCCO显示血管外肺水指数（EVLWI）明显升高（入科即刻为12～42mL／kg，治疗24h为10。22mL／kg），均表现为高通透性肺水肿类型，第1个24h的容量平衡均为正平衡（例1～例4分别为＋1130、＋1200、＋1750、＋1120mL）；治疗中加强胶体的补充，应用多巴胺、多巴酚丁胺、米力农等血管活性药物，循环氧合改善、EVLWI下降。最终3例改善，1例死亡。结论NPE在临床中诊治复杂，治疗过程中出现矛盾多，PiCCO监测技术在早期诊断、鉴别肺水肿类型、指导补液和血管活性药物应用及评估病情、预测预后方面有着较好的作用。

Objective To explore the application value of pulse induced contour cardiac output （PiCCO） monitoring in diagnosis and treatment of patients with neurogenic pulmonary edema （NPE）. Methods With review of literature, the data of 4 patients of severe neurological disease complicated by NPE admitted into Department of Critical Care Medicine of Huangshan People＇s Hospital Affiliated to Wannan Medical College from 2011 to 2013 were retrospectively analyzed and discussed in their PiCCO hemodynamic characteristics and processes of treatment. Results The PiCCO of 4 patients with NPE showed that the extravascular lung water index （EVLWI） was increased significantly （EVLWI was 12 - 42 mL/kg on admission and lO - 22 mL/kg after hospitalization for 24 hours）, all revealing a high permeability pulmonary edema type. The capacity balance of the first 24 hours in the 4 cases was all of positive balance （＋1 130, ＋1 200, ＋1 750, ＋1 120 mL respectively）. In the treatment, the supplementary colloid was strengthened, the vasoactive drugs such as, dopamine, dobutamine, milrinone, etc were applied to improve the circulatory oxygenation, then the EVLWI was declined; finally the disease situation in 3 cases was improved and one died. Conclusions The clinical diagnosis and treatment of NPE is complex, and many contradictions appear in the therapeutic course. PiCCO monitoring is valuable in early diagnosis, identification of pulmonary edema type, guidance in fluid supplement and vascular active drug application, and assessment of disease severity and prognosis.