The direct measurement of plasma colloid osmotic pressure is superior to colloid osmotic pressure derived from albumin or total protein

Plasma colloid osmotic pressure (COP) has been calculated from both serum albumin concentration and plasma total protein concentration. These values have been compared to those measured directly using a membrane-transducer oncometer in a group of normal subjects, in a group of critically-ill patients with a variety of primary diagnoses and in a group of hypovolaemic patients before and after plasma volume replacement with 6% hydroxyethyl starch solution. In the normal samples, COP calculated from albumin (COP_alb) underestimated the measured COP (COP_m) by mean of 2.0 mmHg (p(0.002), with correlation coefficient r=0.39 (n/s). Similarly, the COP_alb underestimated COP_m by a mean of 5.7 mmHg (p(0.001) in the critically ill patient group; r=0.38 (p(0.02). Furthermore, in the patients receiving plasma volume replacement serum albumin concentration fell by 13.1% (p(0.001) whilst COP_m increased by 11.5% (p(0.002). In the normal subjects COP calculated from total protein concentration (COP_tp) underestimated the COP_m by 1.5 mmHg (p(0.02) with r=0.65 (p(0.01). Conversely, in the patient samples, mean COP_tp overestimated COP_m by 3.5 mmHg (p(0.001) with r=0.73 (p(0.002). We conclude that COP_alb is an inadequate estimate of COP_m particularly in patients where its use may have important clinical consequences. COP_tp provides a reasonable estimate of COP_m in normal subjects but in patients samples, where albumin: globulin ratio is low COP_tp overestimates substantially in many cases. We advocate the direct measurement of COP in critically-ill patients.     

The significance of colloid osmotic pressure measurement after crystalloid and colloid infusions

Colloid osmotic pressure (COP) was followed postoperatively in 55 randomized patients. After minor operations and short-term infusion therapy only small changes of the COP could be observed and it was concluded that after such operation COP measurement is unnecessary. After major surgical interventions, however, COP measurement gave valuable hints. It was shown that even in the case of moderate blood loss replaced by crystalloids an abnormally low COP did not occur. The same applied also to preoperative hemodilution. It was unnecessary to substitute the withdrawn blood with a colloid solution. In addition, COP measurement helped to avoid expensive albumin administrations and indicated colloid overload in cases of pulmonary edema.     

血浆胶体渗透压对危重症患者预后的意义

目的 分别对危重症患者血浆胶体渗透压、总渗透压与预后的关系进行研究,探讨其与危重症患者预后的关系.方法 回顾性分析2002年1月至2005年12月入住首都医科大学附属北京朝阳医院急诊重症监护病房(EICU)与外科监护病房(SICU)的1568例患者,依据其入院时的血浆胶体渗透压与总渗透压的测定值分别进行分组,计算其病死率,并且进行X2统计学检验比较.血浆胶体渗透压以20 mmHg(即1.2mOsm/kgH2O)为界分为两组;总渗透压以280 mOsm/kgH2O与310 mOsm/kgH2O为界分为三组.结果 低胶体渗透压组与正常胶体渗透压组患者相比病死率高(24.5% vs.17.7%,P=0.001);而在总渗透压的分析中,低渗透压组与正常渗透压组患者相比病死率低(17.0%vs.24.5%,P=0.000).结论 危重症患者血浆胶体渗透压较总渗透压与预后的关系更为密切,可作为一个危重症患者预后的判断指标,危重症患者维持正常血浆胶体渗透压应当引起重视.     

In vitro colloid osmotic pressure of commonly used plasma expanders and substitutes: a study of the diffusibility of colloid molecules

The rational choice of a plasma substitute for states of hypovolaemia depends partly on its colloid osmotic pressure (COP). We have measured the COP of 108 samples of plasma substitute across selectively permeable membranes which retain molecules greater than 10000 dalton (COP₁₀) and 50000 dalton (COP₅₀) the ratio COP₅₀/COP₁₀ providing a potential index of diffusibility of the smaller molecules across capillary membranes. 6% Hespan solution showed a particularly favourable COP₅₀/COP₁₀ ratio at 0.58 indicating a potential for good retention in the circulation whilst 3.5% Haemaccel showed a COP₅₀/COP₁₀ ratio of 0.18 indicating a potential for marked transcapillary diffusion, especially in states of capillary leak. In patients with normal capillary permeability both Gelofusine and Dextran 110 are likely to show adequate retention in the circulation with a COP₅₀/COP₁₀ ratio of 0.37 and 0.39 respectively. These are comparable to the retention of 4.5% human albumin (0.36) but all of the plasma substitutes tested, with the exception of Haemaccel, provided a higher COP across both membranes than 4.5% human albumin solution. An in vivo comparison of these plasma substitutes is required to confirm the advantages of macromolecular colloids in states of capillary leak.     

羟乙基淀粉对脑缺血/再灌注大鼠颅内压及血浆胶体渗透压的影响

目的 探讨羟乙基淀粉对脑缺血/再灌注(I/R)大鼠血浆胶体渗透压(COP)的调节作用及其对颅内压(ICP)的影响.方法 采用随机对照动物实验研究方法,将24只雄性SD大鼠分为假手术组、模型组和羟乙基淀粉组,每组8只.采用大脑中动脉闭塞法(MCAO)建立脑I/R动物模型,于缺血2 h后再灌注,再灌注开始时尾静脉泵入羟乙基淀粉130/0.4氯化钠注射液206 ml·kg-1·d-1.于术后0、2、6、12、18、24 h分别测定ICP和COP;术后24 h测量右侧大脑半球含水量,用免疫组化法观察神经元凋亡情况.结果 模型组和羟乙基淀粉组术后2 h ICP(mm Hg,1 mm Hg=0.133 kPa)即显著高于假手术组(11.50±1.43、12.48±0.75比7.95±0.92,均P＜0.05),之后随时间延长,两组ICP逐渐升高,至24 h达峰值(22.76±0.72、23.32±0.98比8.15±1.09,均P＜0.05);但羟乙基淀粉组与模型组各时间点比较均无差异.羟乙基淀粉组术后各时间点COP(mm Hg)显著高于模型组和假手术组,于术后6 h达高峰(13.49±0.50比12.04±0.47、12.00±0.39,均P＜0.01);模型组与假手术组各时间点比较均无差异.羟乙基淀粉组和模型组脑组织含水量、神经元凋亡率均显著高于假手术组[脑组织含水量:(80.16±0.44)%、(80.59±0.67)%比(78.72±0.52)%;神经元凋亡率:(44.27±7.86)%、(42.82±7.82)%比(3.26±0.00)%,P＜0.05或P＜0.01];但羟乙基淀粉组与模型组比较差异无统计学意义(均P＞0.05).结论 羟乙基淀粉可以有效提高COP,但尚不能证实提高COP是否能够降低ICP、减轻脑水肿.

Abstract：

Objective To investigate the regulatory effect of hydroxyethyl starch on colloidal osmotic pressure(COP), and its effect on intracranial pressure(ICP)in rats with cerebral ischemia/reperfusion (I/R)injury. Methods Twenty-four male Sprague-Dawley(SD)rats were randomly divided into sham operation group, model group and the hydroxyethyl starch group, each n = 8. Cerebral I/R model was reproduced by middle cerebral artery occlusion(MCAO), followed by reperfusion after ischemia for 2 hours.Rats in hydroxyethyl starch group received hydroxyethyl starch 130/0. 4 206 ml · kg-1 · d-1 via tail vein at the beginning of reperfusion. ICP and COP were evaluated at 0, 2, 6, 12, 18, 24 hours after the surgery.The rats were sacrificed by decapitation. The water content of the right hemisphere was measured at 24 hours after the surgery, and the ratio of apoptosis of neurons was observed by immunohistochemical method. Results Two hours after surgery the ICP(mm Hg, 1 mm Hg=0.133 kPa)of model group and hydroxyethyl starch group was significantly increased compared with sham operation group(11. 50±1.43,12. 48±0. 75 vs. 7. 95±0. 92, both P＜0. 05). With prolongation of time, the ICP gradually increased and reached the peak at 24 hours(22. 76±0. 72, 23. 32±0. 98 vs. 8. 15±1.09, both P＜0. 05). But there was no significant difference in ICP in the hydroxyethyl starch group compared with that of the model group at all time points. The COP(mm Hg)of hydroxyethyl starch group was significantly higher than the model group and sham operation group at each time point, and peaked at 6 hours after surgery(13. 49±0. 50 vs. 12.04±0. 47, 12. 00±0. 39, both P＜0. 01). There was no significant difference in COP between the model group and the sham operation group at all time points. The brain water content, neuronal apoptosis of hydroxyethyl starch group and model group was significantly higher than sham operation group[brain water content:(80. 16 ± 0. 44)%,(80. 59 ± 0. 67)% vs.(78. 72 ± 0. 52)%; neuronal apoptosis:(44. 27 ± 7. 86)%,(42. 82 ± 7.82)% vs.(3. 26 ± 0. 00)%, P ＜ 0. 05 or P ＜ 0. 01], but there was no significant difference between the hydroxyethyl starch group and model group(both P＞0. 05). Conclusion Intravenous injection of hydroxyethyl starch 130/0.4 can increase the plasma COP, but it can not significantly reduce ICP and brain water content, and it also can not improve the neuronal apoptosis.     

无创正压通气治疗急性心源性肺水肿的临床疗效观察

目的：观察无创正压通气（ NPPV）治疗急性心源性肺水肿的临床疗效。方法对48例急性心源性肺水肿引起的急性呼吸衰竭患者行NPPV，观察治疗期间心率和经皮血氧饱和度的变化，比较治疗前及治疗后2 h血气情况。结果急性心源性肺水肿患者治疗后2h缺氧症状得到明显改善，心悸、呼吸困难及紫绀明显好转，心功能评级明显降低（P﹤0.01）。结论对急性心源性肺水肿引起的急性呼吸衰竭行NPPV疗效显著，具有良好的临床实用价值，值得推广。     

Alveolar edema dispersion and alveolar protein permeability during high volume ventilation: effect of positive end-expiratory pressure

Objectives To evaluate whether PEEP affects intrapulmonary alveolar edema liquid movement and alveolar permeability to proteins during high volume ventilation. Design and setting Experimental study in an animal research laboratory. Subjects 46 male Wistar rats. Interventions A ^99mTc-labeled albumin solution was instilled in a distal airway to produce a zone of alveolar flooding. Conventional ventilation (CV) was applied for 30 min followed by various ventilation strategies for 3 h: CV, spontaneous breathing, and high volume ventilation with different PEEP levels (0, 6, and 8 cmH₂O) and different tidal volumes. Dispersion of the instilled liquid and systemic leakage of ^99mTc-albumin from the lungs were studied by scintigraphy. Measurements and results The instillation protocol produced a zone of alveolar flooding that stayed localized during CV or spontaneous breathing. High volume ventilation dispersed alveolar liquid in the lungs. This dispersion was prevented by PEEP even when tidal volume was the same and thus end-inspiratory pressure higher. High volume ventilation resulted in the leakage of instilled ^99mTc-albumin from the lungs. This increase in alveolar albumin permeability was reduced by PEEP. Albumin permeability was more affected by the amplitude of tidal excursions than by overall lung distension. Conclusions PEEP prevents the dispersion of alveolar edema liquid in the lungs and lessens the increase in alveolar albumin permeability due to high volume ventilation. This research was supported by a grant from the French Académie Nationale de Médecine     

Unilateral pulmonary hemorrhage caused by negative pressure pulmonary edema: A case report

BACKGROUNDUnilateral pulmonary hemorrhage is typically reported in young and healthy men with upper respiratory tract obstruction during anesthesia in special situations. Negative pressure in the lungs is created, resulting in negative pressure pulmonary edema (NPPE). CASE SUMMARYA 78-year-old male patient diagnosed with spinal stenosis was admitted to receive a unilateral laminectomy with bilateral decompression. The patient had been diagnosed with hypertension four years earlier and asthma more than 70 years earlier. We experienced a unilateral alveolar hemorrhage associated with NPPE that occurred in a longstanding asthma patient who bit the intubated endotracheal tube for a short period during posture change at the end of surgery. Because diffuse alveolar hemorrhage accompanied by NPPE was caused in this case by airway obstruction in an older patient with asthma without known risk factors, anesthesiologists should be careful not to induce airway irritation during anesthesia awakening in asthma patients.CONCLUSIONBecause diffuse alveolar hemorrhage accompanied by NPPE can occur, anesthesiologists should take care not to induce airway irritation.     

特布他林对海水淹溺型肺水肿兔肺水吸收的影响

目的 观察特布他林对海水淹溺型肺水肿(PE-SWD)兔肺水吸收的影响.方法 36只新西兰兔的PE-SWD机械通气模型,随机分成正常组(N组)、对照组(C组)和特布他林治疗组(T组).在不同时间点观察动脉血气分析,检测三组的血管外肺水含量指数(EVLWI)、伊文思兰漏出(ELI)指数,同时分别用RT-PCR和Western印迹检测肺组织中钠离子通道-α亚单位mR-NA(α-ENaC mRNA)和钠钾泵-α1亚单位(NKA-α1)蛋白的丰度,用水解法检测肺组织匀浆中Na -K -ATP酶(NKA)活性,并对肺组织进行病理学检查.结果 特布他林干预后PE-SWD兔血氧分压(PaO2)、二氧化碳分压(PaCO2)等均较对照组有明显改善(P<0.05).T组EVLWI显著低于C组(P<0.05),而α-ENaC mRNA和NKA-α1蛋白的丰度及NKA活性均显著的高于相应的C组(P<0.05),NKA活性也显著的高于C组(P<0.05).结论 特布他林可增加肺泡钠水转运系统的表达或活性来促进PE-SWD兔肺水的吸收,减轻肺水肿.     

不同容量平衡盐液对初进高原大鼠失血性休克合并肺水肿的复苏效果

目的 :探讨不同容量平衡盐液对初进高原大鼠失血性休克合并肺水肿的复苏效果 ,明确其液体复苏有效量及限量。方法 :初进高原 (西藏拉萨 ) SD大鼠 12 6只 ,戊巴比妥钠麻醉 ,维持血压 5 0 m m Hg( 1mm Hg=0 .133 k Pa) 1h加油酸 ( 5 0μl/ kg)静脉注射复制失血性休克合并肺水肿模型 (正常对照组不放血、不给油酸 )。第一部分实验 6 3只大鼠分为正常对照组、单纯失血性休克不复苏组、失血性休克合并肺水肿不复苏组、失血性休克合并肺水肿输注失血量 0 .5倍、1倍、1.5倍、2倍和 3倍的乳酸林格氏液 ( L R)和 1倍失血量 L R加甘露醇( 10 m l/ kg)组 ,观察液体输注后 15、30、6 0和 12 0 m in的血流动力学指标变化 ,30和 12 0 min的血气指标变化和 12 0 min肺、脑含水量变化 ,每组 7只动物。第二部分实验观察不同容量 L R输注对休克大鼠存活时间的影响。结果 :0 .5倍容量 L R输注可明显改善休克大鼠平均动脉压 ( MAP)、左心室内压 ( L VSP)和左心室内压最大变化速率 (± dp/ dt max)等血流动力学指标 ,延长存活时间 ( P均 <0 .0 1) ,不增加休克动物肺、脑含水量 ,对血气指标无明显影响 ;1倍容量 L R输注可轻度改善休克动物血流动力学指标 ,轻度延长存活时间 ,增加肺含水量 ,对血气指标无显著影响 ;1.5倍、 2倍     

成人心脏围术期胶体渗透压变化及其临床意义

目的 探讨成人心脏外科手术围术期血浆胶体渗透压(COP)的变化规律。方法 选择21例行成人心脏外科手术的患者,根据手术不同分为体外循环瓣膜置换组(CPB组)、微创不停跳冠脉搭桥组(OP组)。记录麻醉后5min(T0)、体外循环开始后5min/搭桥血管远端时(T1)、体外循环结束后5min/搭桥血管近端时(T2)、手术结束返回ICU(T3)、术后2h(T4)、4h(T5)、8h(T6)、24h(T7)的COP,以及术后3d检验指标的变化、机械通气时间、ICU时间等数据。比较各时间点的数据差异。结果 所有患者术前基本情况相同。2组患者围术期COP均有下降,但组间比较差异无统计学意义(P0.05)。CPB组在术中COP变化值最明显,差异有统计学意义(P0.05)。2组的并发症发生率及术后ICU时间、机械通气时间比较,差异均无统计学意义(P0.05)。结论 心脏体外循环手术可使COP下降,但通过纠正COP均能恢复正常,对临床预后无明显影响。     

Noninvasive pressure support ventilation vs. continuous positive airway pressure in acute hypercapnic pulmonary edema

Objective This study compared noninvasive pressure support ventilation (NIPSV) and continuous positive airway pressure (CPAP) in patients with acute hypercapnic pulmonary edema with regard to resolution time.Design and setting Randomized prospective study in an emergency department.Patients and participants We randomly assigned 36 patients with respiratory failure due to acute pulmonary edema and arterial hypercapnia (PaCO₂ >45 mmHg) to NIPSV (n=18) or CPAP through a face mask (n=18).Measurements and results Electrocardiographic and physiological measurements were made over 36 h. There was no difference in resolution time defined as clinical improvement with a respiratory rate of fewer than 30 breaths/min and SpO₂ of 96% or more between CPAP and NIPSV groups. Arterial carbon dioxide tension was significantly decreased after 1 h of ventilation (CPAP, 60.5±13.6 to 42.8±4.9 mmHg; NIPSV, 65.7±13.6 to 44.0±5.5 mmHg); respective improvements were seen in pH (CPAP, 7.22±0.11 to 7.37±0.04; NIPSV, 7.19±0.11 to 7.38±0.04), SpO₂ (CPAP, 86.9±3.7% to 95.1±2.6%; NIPSV, 83.7±6.6% to 96.0±2.9%), and respiratory rate (CPAP, 37.9±4.5 to 21.3±5.1 breaths/min; NIPSV, 39.8±4.4 to 21.2±4.6 breaths/min). No significant differences were seen with regards to endotracheal intubation and in-hospital mortality.Conclusions NIPSV proved as effective as CPAP in the treatment of patients with acute pulmonary edema and hypercapnia but did not improve resolution time.     

肺泡内液体清除与肺水肿的研究进展

肺水肿是急性肺损伤(ALI)病理进程中的中心环节,与肺泡毛细血管通透性增加和肺泡内液体清除减少有关。以往对肺泡毛细血管通透性导致的肺水肿研究较多,而对肺泡内液体清除在肺水肿形成中的作用关注不足。肺泡内液体清除受水通道蛋白、钠离子通道、钠钾ATP酶的影响。认识肺泡内液体清除机制有望能为临床医师治疗ALI提供参考。     

无创与有创正压通气防治重症手足口病神经源性肺水肿的疗效分析

目的：探讨无创与有创正压通气对防治重症手足口病神经源性肺水肿（ NPE）的疗效分析。方法选择2011－05～2014－04入住我院的重症手足口病患者（2、3期）228例,分为对照组（2期）70例,按照常规治疗;经鼻持续正压气道通气（ CPAP）组108例,常规治疗基础上加简易经鼻持续气道正压通气;呼吸机组50例,常规治疗的基础上加有创机械通气。结果2期CPAP组与对照组及呼吸机组（2期）的治愈好转率比较差异无统计学意义（P＝0．26,0．156）;3期呼吸机组的病程较CPAP组短（P＝0．000）,但呼吸机组的血糖水平高于CPAP组,两组比较差异有统计学意义（ P＝0．05）;3期呼吸机组进展到4期的有8例均合并NPE明显高于3期CPAP组（ P＝0.004）,5例死于肺出血,病死率62.5％,3期呼吸机组的最终病死率高于CPAP组（ P＜0.01）。结论目前没有临床依据推荐在2期重症手足口病常规使用机械通气;经鼻持续气道正压通气对3期危重症手足口病的症状改善、阻止病情进展、防治神经源性肺水肿及在减少有创机械通气使用方面具有肯定的疗效与优势。     

不同通气方式对兔海水型肺水肿的治疗作

目的　观察不同的通气方式对海水淹溺型肺水肿 (PE -SWD)的救治作用。方法　应用常规机械通气 (SMV)和高频喷射通气 (HFJV)对PE -SWD兔进行分组救治 ,在不同时间点观察血气分析、呼吸动力学、肺损伤指标 ,并进行病理学检查和观察存活时间。结果　两种通气方式治疗后PE -SWD兔血氧分压 (PaO2 )、血氧饱和度 (SO2 )、二氧化碳分压 (PaCO2 )均较未治疗组有明显改善 (P <0 0 1) ,呼吸动力学、血流动力学异常得到一定程度纠正 ,TNF -α、肺泡灌洗液中性粒细胞计数等肺损伤指标也显示通气治疗后肺损伤程度减轻。两种通气方式之间比较显示SMV较HFJV治疗能更好地改善PE -SWD时的低氧情况。结论　CMV和HFJV通气治疗PE -SWD时低氧血症均取得满意效果 ,并减轻了肺损伤的程度。     

不同氧疗方式对兔海水淹溺肺水肿的治疗作用

目的　观察不同氧疗方式对海水淹溺肺水肿 (PE -SWD)的治疗作用。方法　实验动物随机分为正常对照组、海水淹溺组、高压氧 (HBO)治疗组、机械通气 (MV)组。在不同时间点观察动脉血气分析、生命体征、肺损伤指标 ,并进行病理学检查和观察存活时间。结果　两种氧疗方式治疗后PaO2 、SaO2 较海水淹溺组有明显改善 (P <0 0 1) ,异常的生命体征得到一定程度纠正 ,肺损伤程度减轻。治疗组动物存活时间明显延长 ,且机械通气组优于高压氧组。结论　高压氧和机械通气治疗可明显控制PE -SWD时的低氧血症 ,并减轻肺损伤程度     

肺表面活性蛋白-D在高原肺水肿发生发展中的表达及作用

目的探讨肺表面活性蛋白-D（SP-D）在高原肺水肿发生发展中的表达及作用。 方法将64只Wistar雄性大鼠随机分为4组,正常对照组（16只,586 m室温饲养）,低压低氧24 h、48 h及72 h组（各16只,于模拟海拔6000 m低压低氧舱内分别饲养24 h、48 h及72 h）,取右侧肺组织行HE染色,观察肺组织损伤情况,收集左侧肺组织肺泡灌洗液,采用酶联免疫吸附法（ELISA）测定支气管肺泡灌洗液（BALF）中SP-D、白介素（IL）-1β、IL-6、C反应蛋白（CRP）及肿瘤坏死因子α（TNF-α）的含量。 结果成功建造高原肺水肿动物模型;与正常对照组相比,低压低氧24、48、72 h组肺组织病理评分升高,差异有统计学意义（P＜0.05）;SP-D含量均有所下降,IL-1β、IL-6、CRP、TNF-α含量均上升,且各组间两两比较差异均有统计学意义（P＜0.05）;BALF中SP-D含量与肺组织病理评分呈负相关（r=-0.687,P＜0.05）,炎症因子IL-1β、IL-6、CRP及TNF-α与肺组织病理评分均呈正相关（r=0.705,P＜0.05;r=0.728,P＜0.05;r=0.733,P＜0.05;r=0.737,P＜0.05）。 结论SP-D在高原肺水肿的发生发展中起着一定的作用,其可能是防治高原肺水肿的新靶点。     

Colloid osmotic pressures,plasma volume and interstitial fluid volume in patients with heart failure

Fauchald P. Colloid osmotic pressures, plasma volume and interstitial fluid volume in patients with heart failure. Scand J Clin Lab Invest 1985; 45: 701–706.

In 13 patients with heart failure colloid osmotic pressure in plasma (II_p) and in subcutaneous interstitial fluid from thorax (II_i) (wick technique), plasma volume (PV) and interstitial fluid volume (IFV) were measured and correlated to haemodynamic parameters (cardiac index (CI) and right atrial pressure (RAP)). In seven patients with anasarca measurements of II_P, II_i, PV and IFV were repeated after fluid withdrawal (mean 7786 ml) by ultrafiltration. In the patients, IIj was reduced compared with normal subjects (11.5±3.4 versus 15.8±2.7 mmHg, p<0.01 (mean±SD)) and transcapillary colloid osmotic gradient (II_p - II_i) increased (14.6±2.3 versus 12.8±2.7 mmHg, p<0.05). The IFV in the patients was increased to 137% of values in normal subjects (p<0.01) and the ratio PV/IFV significantly reduced. Correlations were found between II_i and CI(r=0.69, p<0.01) and II; and RAP (r=0.78, p<0.01). Ultrafiltration led to a parallel decrease in PV and IFV and increase in II_p. The results indicate that reduced II_i is an important factor limiting peripheral oedema in heart failure and the reduction is more pronounced in severe heart failure. The reduction of II_i is due to both dilution of interstitial proteins and to reduction of interstitial protein mass by lymphatic wash-out.     

L-精氨酸治疗高原肺水肿患者的临床疗效及对血流动力学变化的影响

目的 评价L-精氨酸对高原肺水肿患者的疗效及机制。方法 采用右心漂浮导管的研究方法，观察了静滴L-精氨酸对患者血流动力学及动脉血气等方面的影响，同时采用Lake评分法对患者的病情进行定量评估。结果 L-精氨酸能降低HAPE患者的肺动脉压和肺血管阻力，能提高患者动脉氧分压及血氧饱和度，而对体循环及心率未见明显影响；应用L-精氨酸后，HAPE患者病情定量分数亦明显低于用药前。结论 L-精氨酸能明显改善HAPE的临床症状，且有明显降低HAPE患者肺动脉高压的作用。     

面罩双向正压通气治疗急性肺水肿的疗效评价

目的　评价面罩双向正压机械通气治疗急性肺水肿的疗效及安全性。方法　对 6 0例各种病因所致的急性肺水肿患者随机分组 ,治疗组采用常规药物治疗加BiPAP面罩ST -D - 2 0呼吸机双向正压通气 ,对照组常规药物治疗加鼻导管吸氧。结果　治疗组无创面罩通气后 ,2 8例患者在 30min～ 2h症状好转 ,呼吸减慢 ,心率下降 ,肺部湿 口罗音减少 ,PaO2 上升 ,PCO2 下降 ,与治疗前相比有显著差异 (P <0 0 1) ,总有效率 93 3%。对照组在相应时间仅 19例好转 ,有效率 6 3 3%。两组相比差异显著 (P <0 0 5 )。结论　BiPAP面罩双向正压机械通气治疗急性肺水肿效果显著 ,安全可行。