Neurogenic Pulmonary edema(NPE)is a well known complication of severe central nervous system insult,such as subarachnoid hemorrhage(SAH).Endogenous catecholamines can result in NPE.Cardio-respira-tory dysfunction may ...Neurogenic Pulmonary edema(NPE)is a well known complication of severe central nervous system insult,such as subarachnoid hemorrhage(SAH).Endogenous catecholamines can result in NPE.Cardio-respira-tory dysfunction may present severer than the clinical symptom of SAH.ICU management for patients with NPE after SAH is recommended.We describe a patient with NPE after SAH.The rapid development of respiratory and cardiac impairment had masked the initial disease.展开更多
Pulmonary injury after acute H<sub>2</sub>S inhalation was studied with bronchoalveolar lavage（BAL）,ultracentrifuge,and optical and electron microscopy.The changes of the activities oflactate dehydrogena...Pulmonary injury after acute H<sub>2</sub>S inhalation was studied with bronchoalveolar lavage（BAL）,ultracentrifuge,and optical and electron microscopy.The changes of the activities oflactate dehydrogenase,alkaline and acid phosphatase,and angiotension converting enzymes inBAL fluid were used as the indicator of cellular damages,those of leucocytic count and the indi-cator of inflammatory response,and those of the concentration of protein and Evans blue as theindicator of vascular permeability.In addition the effects of H<sub>2</sub>S on lipid peroxidation,naturalantioxidative system and energy substances and the changes of phospholipid concentration inBAL fluid were also observed.The results were as follows:1.Inhalation of H<sub>2</sub>S exerted a severe cytotoxic effect on the lung tissues resulting in dam-ages on various types of cells and a severe edematogenic effect on lung parenchyma.2.The development of pulmonary edema in H<sub>2</sub>S intoxication resulted from a combination ofdifferent pathogenic factors.3.The biochemical changes and their recovery occurred earlier than the pathologicalchanges and their recovery.The efficacy of 6 categories of drugs including 25 medicaments against H<sub>2</sub>S intoxication wasevaluated in mice,and 10 drugs were found to be prophylactically effective.The effects of vari-ous methemoglobin-forming agents and some other drugs were also studied in their treatment ofH<sub>2</sub>S intoxication in rabbits and dogs.It was concluded that methemoglobin-forming agentscould be used as specific antidotes but could not provent or alleviate the lung damages due toH<sub>2</sub>S inhalation unless they were administered in association with dexamethasone,vitamin E oranisodamine.A scheme of the medical treatment for H<sub>2</sub>S intoxication was presented.展开更多
目的观察参附注射液联合亚低温治疗重型颅脑损伤并发神经源性肺水肿(Neurogenic Pulmonary Edema,NPE)患者的临床疗效。方法选取2019年1月—2021年5月期间郑州大学附属郑州中心医院EICU及神经外科住院患者70例,采用随机数字表法分为观...目的观察参附注射液联合亚低温治疗重型颅脑损伤并发神经源性肺水肿(Neurogenic Pulmonary Edema,NPE)患者的临床疗效。方法选取2019年1月—2021年5月期间郑州大学附属郑州中心医院EICU及神经外科住院患者70例,采用随机数字表法分为观察组和对照组,每组各35例。两组患者均予以常规西医治疗,对照组仅采用亚低温治疗,观察组采用参附注射液联合亚低温治疗。治疗7 d后,观察比较两组患者治疗前后格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、美国国立卫生研究院卒中量表评分(National Institute of Health stroke scale,NIHSS)、血气分析指标[氧合指数、动脉血氧饱和度(Oxygen saturation of blood,SaO_(2))、二氧化碳分压(Partial Pressure of Carbon Dioxide,PaCO_(2))、动脉血氧分压(Partial pressure of oxygen,PaO_(2))]、肺循环相关指标[肺血管通透指数(Pulmonary Vascular Permeability Index,PVPI)、血管外肺水指数(Extra Vascular Lung Water Index,EVLWI)]、血清神经体液指标[去甲肾上腺素(Norepinephrine,NE)、促肾上腺皮质激素(Adreno-cortico-tropic-hormone,ACTH)、皮质醇(Cortisol,Cor)]及临床结局情况。结果治疗后两组患者GCS评分均较治疗前升高,NIHSS评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组GCS评分高于对照组,NIHSS评分低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者氧合指数、SaO_(2)、PaCO_(2)、PaO_(2)均较治疗前升高,PVPI、EVLWI均较治疗前降低,差异有统计学意义(P<0.05);且观察组氧合指数、SaO_(2)、PaCO_(2)、PaO_(2)高于对照组,PVPI、EVLWI低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清Cor、ACTH、NE水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组血清Cor、ACTH、NE水平低于对照组,差异有统计学意义(P<0.05)。治疗后观察组昏迷时间、ICU入住时间、机械通气时间及死亡例数低于对照组,差异有统计学意义(P<0.05)。结论参附注射液联合亚低温能有效改善重型颅脑损伤并发NPE患者临床结局,促进神经功能恢复,改善血氧交换功能及肺血管通透性,调节机体神经体液水平。展开更多
文摘Neurogenic Pulmonary edema(NPE)is a well known complication of severe central nervous system insult,such as subarachnoid hemorrhage(SAH).Endogenous catecholamines can result in NPE.Cardio-respira-tory dysfunction may present severer than the clinical symptom of SAH.ICU management for patients with NPE after SAH is recommended.We describe a patient with NPE after SAH.The rapid development of respiratory and cardiac impairment had masked the initial disease.
文摘Pulmonary injury after acute H<sub>2</sub>S inhalation was studied with bronchoalveolar lavage（BAL）,ultracentrifuge,and optical and electron microscopy.The changes of the activities oflactate dehydrogenase,alkaline and acid phosphatase,and angiotension converting enzymes inBAL fluid were used as the indicator of cellular damages,those of leucocytic count and the indi-cator of inflammatory response,and those of the concentration of protein and Evans blue as theindicator of vascular permeability.In addition the effects of H<sub>2</sub>S on lipid peroxidation,naturalantioxidative system and energy substances and the changes of phospholipid concentration inBAL fluid were also observed.The results were as follows:1.Inhalation of H<sub>2</sub>S exerted a severe cytotoxic effect on the lung tissues resulting in dam-ages on various types of cells and a severe edematogenic effect on lung parenchyma.2.The development of pulmonary edema in H<sub>2</sub>S intoxication resulted from a combination ofdifferent pathogenic factors.3.The biochemical changes and their recovery occurred earlier than the pathologicalchanges and their recovery.The efficacy of 6 categories of drugs including 25 medicaments against H<sub>2</sub>S intoxication wasevaluated in mice,and 10 drugs were found to be prophylactically effective.The effects of vari-ous methemoglobin-forming agents and some other drugs were also studied in their treatment ofH<sub>2</sub>S intoxication in rabbits and dogs.It was concluded that methemoglobin-forming agentscould be used as specific antidotes but could not provent or alleviate the lung damages due toH<sub>2</sub>S inhalation unless they were administered in association with dexamethasone,vitamin E oranisodamine.A scheme of the medical treatment for H<sub>2</sub>S intoxication was presented.
文摘目的观察参附注射液联合亚低温治疗重型颅脑损伤并发神经源性肺水肿(Neurogenic Pulmonary Edema,NPE)患者的临床疗效。方法选取2019年1月—2021年5月期间郑州大学附属郑州中心医院EICU及神经外科住院患者70例,采用随机数字表法分为观察组和对照组,每组各35例。两组患者均予以常规西医治疗,对照组仅采用亚低温治疗,观察组采用参附注射液联合亚低温治疗。治疗7 d后,观察比较两组患者治疗前后格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、美国国立卫生研究院卒中量表评分(National Institute of Health stroke scale,NIHSS)、血气分析指标[氧合指数、动脉血氧饱和度(Oxygen saturation of blood,SaO_(2))、二氧化碳分压(Partial Pressure of Carbon Dioxide,PaCO_(2))、动脉血氧分压(Partial pressure of oxygen,PaO_(2))]、肺循环相关指标[肺血管通透指数(Pulmonary Vascular Permeability Index,PVPI)、血管外肺水指数(Extra Vascular Lung Water Index,EVLWI)]、血清神经体液指标[去甲肾上腺素(Norepinephrine,NE)、促肾上腺皮质激素(Adreno-cortico-tropic-hormone,ACTH)、皮质醇(Cortisol,Cor)]及临床结局情况。结果治疗后两组患者GCS评分均较治疗前升高,NIHSS评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组GCS评分高于对照组,NIHSS评分低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者氧合指数、SaO_(2)、PaCO_(2)、PaO_(2)均较治疗前升高,PVPI、EVLWI均较治疗前降低,差异有统计学意义(P<0.05);且观察组氧合指数、SaO_(2)、PaCO_(2)、PaO_(2)高于对照组,PVPI、EVLWI低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清Cor、ACTH、NE水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组血清Cor、ACTH、NE水平低于对照组,差异有统计学意义(P<0.05)。治疗后观察组昏迷时间、ICU入住时间、机械通气时间及死亡例数低于对照组,差异有统计学意义(P<0.05)。结论参附注射液联合亚低温能有效改善重型颅脑损伤并发NPE患者临床结局,促进神经功能恢复,改善血氧交换功能及肺血管通透性,调节机体神经体液水平。
