神经源性肺水肿27例诊疗分析

目的：分析神经源性肺水肿（NPE）的诊断及治疗要点。方法分析27例重型颅脑损伤并发NPE患者的临床表现、实验室及辅助检查、治疗方法及预后等。结果27例患者入院后及时完善相关检查并及早明确NPE诊断。所有患者均出现进行性呼吸困难，气道内有大量淡红或粉红色泡沫痰；PaO2均＜60 mm Hg；胸部X线片及CT检查均可见阴影或渗出；颅脑CT检查均可见血肿或出血灶。明确诊断后立即进行抢救，严密监测患者生命体征、痰液痰量、心输出量等，动态监测血气，定时复查胸部X线片。5例采用内科保守治疗，主要为减轻脑水肿、预防脑血管痉挛、营养脑神经、预防继发性癫痫发作及预防感染等，疗程1～3周。22例采用外科手术治疗，术后再行上述内科治疗。经治疗后，13例（48％）患者好转，于住院后1．5～2个月出院，出院时一般情况均稳定。14例（52％）死亡，死于再发脑出血9例、并发肺部感染5例。结论早诊断早治疗对NPE患者有益，在兼顾颅内病变和肺水肿的同时应积极抗感染，防治并发症。

Clinical analysis of 27 cases with Neurogenic pulmonary edema

Objective To analyze the clinical characteristics and treatment of neurological pulmonary edema （NPE）.Methods Clinical data of 27 cases of serious brain damage complicated with NPE were ana-lyzed,including their clinical features,treatment and prognosis.Results Relevant inspections were finished and NPE diagnosis was confirmed immediately in 27 patients after hospitalization.All cases had progressive dyspnea,with great amount of pale red or pink frothy sputum in there airway;PaO2 ＆lt;60 mm Hg.Chest X ray and CT examination showed shadows or leakage.Craniocerebral CT examination showed hematoma or bleeding. All patients were treated immediately after diagnosis.Their vital signs,sputum volume,cardiac output and blood gas analysis were closely monitored,chest X ray reviewed regularly.Five patients received medical treat-ment of 1 ~3 weeks,including relieving cerebral edema,cranial nerve nutrition,preventing cerebral vasospasm and secondary epilepsy seizures,together with infection control.Twenty-two patients received surgical treatment in addition of the above management.After treatment,thirteen patients （48%）were rescued and discharged after 1 .5-2 months.Fourteen patients died of recurrent cerebral hemorrhage or pulmonary infection.Conclu-sion Early diagnosis and treatment are beneficial for NPE patients.Intracranial lesions and pulmonary edema should be controlled at the same time,as well as preventions of infection and other complications.