淡水淹溺后肺水肿的治疗

以间歇正压通气或呼气末期正压通气及高压氧治疗为主的综合疗法,救治了10例淡水淹溺后严重肺水肿的患者,8例成活。通气模式在决定肺水肿的去留上有决定作用。只有消除自主呼吸,实施控制通气才能控制肺水肿。凡增加肺泡内负压的因素,如自主吸气,吸痰、咳嗽等可能加重肺水肿,呼气末期正压通气的效果优于间歇正压通气,在正压通气同时行高压氧治疗,对肺水肿和脑缺氧抽搐有迅速的控制作用,也可避免使用高吸气或呼气末压造成的心、肺、脑不良效应。本文讨论了水也解质平衡等问题,并认为强心、利尿、大剂量东茛菪碱等对治疗淡水淹溺后肺水肿无效。

Treatment of pulmonary edema after fresh water near drowning

Ten pattients with severe pulmonary edema caused by fresh water drowning was treated by intermitent positive pressure ventilation (IPPV) or positive end-expiratory pressure ventilation (PEEP) with hyperbaric oxygenation.Eight patients survived.The model of mechanical ventilation played a decisive role in prognosis of the pulmonary edema.Only when spontaneous breathing was inhibited and replaced by controlled ventilation,the pulmonary edema could be controlled.All facts that increased inspiratory negative pressured,such as spontaneous inspiration,intratracheal suction and coughing,showed significant deterioration in gas exchange. Hyperbtarie oxygen therapy in combination with positive pressure ventilation can promptly control the pulmonary edema and convulsions due to cerebral hypoxia.It avoided side effests of high end-inspiratory or end-expiratory pressure on heart,lung and brain. The article discussed the problem of fluid therapy and blood gas assessment.We found that digitalises,diureties,scopolamine and large doses of corticosteroids on pulmonary edema after fresh water drowning had no value.