脑出血昏迷患者神经源性肺水肿的治疗

Treatment of early neurogenic pulmonary edema in coma patients with cerebral hemorrhage

目的探讨脑出血昏迷患者神经源性肺水肿(NPE)的早期诊断,针对神经源性肺水肿发病机制拟定治疗方案,评价疗效。方法回顾性分析2011年4月至2016年9月延安大学附属医院神经外科120例脑出血昏迷患者。扩血管、降低血管通透性和提高胶体渗透压为主治疗的为治疗组,未按照上述方法治疗的为对照组,每组各60例。观察3周内因肺部并发症导致不良预后的病例,患者的呼吸频率、吸痰次数、指血氧饱和度、胸部CT情况。结果治疗3 d后2组在呼吸频率、吸痰次数、指血氧饱和度变化具有差异(P<0. 05);治疗1~3 d胸部CT扫描,91例出现不同程度的双肺对称性云雾状改变或片状实变,双侧胸腔积液,与发病当天的胸部CT相比有差异(P<0. 05); 3周内,治疗组因肺部并发症出现不良预后病例5例,低于对照组的29例(P<0. 05)。结论脑出血昏迷患者用扩血管、降低血管通透性和提高胶体渗透压等治疗,成为早期NPE治疗的有效措施。

Objective To investigate the early diagnosis of neurogenic pulmonary edema(NPE)in coma patients with cerebral hemorrhage,and to formulate the treatment plan and evaluate the curative effect according to the pathogenesis of neurogenic pulmonary edema.Methods 120 coma patients with cerebral hemorrhage in the Neurosurgery Department of the Yan an University Affiliated Hospital from April 2011 to September 2016 were reviewed.Sixty patients in the treatment group received the treatment for dilating blood vessel,reducing blood vessel permeability and enhancing colloid osmotic pressure.Sixty patients in the control group did not receive the treatment.The respiratory rate,the number of sputum suction,the saturation of blood oxygen,the chest CT,and the complications caused by pulmonary complications within 3 weeks were observed.Results The respiratory rate,the number of sputum suction and the changes of blood oxygen saturation were significantly different 3 days after treatment in two groups(P<0.05).Chest CT within 3 days after treatment revealed that double symmetrical,cloudy or patchy changes of bilateral pulmonary pleural effusion aggravated in 91 patients,which were different compared with the beginning(P<0.05).Within 3 weeks,the treatment group had 5 cases of adverse pulmonary complications,which were significantly less than 29 cases in the control group(P<0.05).Conclusions In coma patients with cerebral hemorrhage,it is effective to treat neurogenic pulmonary edema by expanding blood vessel,reducing blood vessel permeability and enhancing colloid osmotic pressure.