蛛网膜下腔出血并发神经源性肺水肿临床分析

Clinical investigation of neurogenic pulmonary edema complicated by subarachnoid hemorrhage

目的探讨蛛网膜下腔出血并发神经源性肺水肿的临床特点。方法对224例符合入选标准的蛛网膜下腔出血患者的临床资料进行回顾性分析。结果蛛网膜下腔出血并发神经源性肺水肿的发生率为8．5％，73．7％的肺水肿发生于蛛网膜下腔出血后24h内。入院HUNT—HESS分级高、心肌酶升高是蛛网膜下腔出血患者并发神经源性肺水肿的危险因素。并发神经源性肺水肿的患者头颅CT均表现为严重出血。并发神经源性肺水肿的患者中有12例行DSA等检查，均提示有动脉瘤，其中7例患者动脉瘤位于颈内动脉一后交通动脉。并发神经源性肺水肿的患者大部分给予气管插管连接呼吸机辅助通气。并发神经源性肺水肿的蛛网膜下腔出血患者30天内病死率为26．3％，明显高于未并发神经源性肺水肿的患者。结论神经源性肺水肿是蛛网膜下腔出血严重的并发症之一，并发神经源性肺水肿的患者预后差，临床上应高度重视，加强防治。

Objective To observe clinical characteristics of subarachnoid hemorrhage （SAH） complicating complicated with neurogenic pulmonary edema （NPE）. Methods Two hundred and twenty-four patients with subarachnoid hemorrhage were enrolled, and their medical records were retrospectively analyzed. Results The incidence of subarachnoid hemorrhage complicating with neurogenic pulmonary edema was 8.5%. Neurogenic pulmonary edema typically occurred within 24 hours after subarachnoid hemorrhage. In multivariate logistic regression analysis, the important risk factors for the development of NPE included high HUNT-HESS grades and elevated cardiac enzymes levels on admission. Patients with NPE were severely impaired and all of them presented with severe hemorrhage in head CT. All of 12 patients with NPE who received DSA examinations presented with aneurysm, and there were 7 patients＇ aneurysm located on internal carotid artery - posterior communicating artery. The majority of patients with neurogenic pulmonary edema were treated with mechanical ventilation. Mortality rate in patients complicating with NPE in 30 days was 26.3 %, significantly higher than those who without NPE. Conclusion NPE is a potentially life-threatening complication after SAH. Subarachnoid hemorrhage complicating with neurogenic pulmonary edema has a poor prognosis and should be given close attention in clinical practice.