急性肺水肿的临床特点及抢救(附78例分析)

目的 总结急性肺水肿(acute pulmonary edema，APE)的临床特点及抢救治疗经验。方法 对78例APE病例的抢救治疗进行回顾性分析。结果 (1)78例患者抢救成功56例(71．8％)，死亡22例(28．2％)；(2)36例行气管插管人工机械通气，21例(58．3％)抢救成功；(3)40例应用小剂量吗啡，32例(80．0％)抢救成功，无1例出现呼吸抑制；(4)急性毒品中毒11例均有不同程度呼吸抑制，全部应用呼吸兴奋剂及阿片类拮抗剂纳络酮，10例(90．9％)抢救成功；(5)伴低血压21例，加用多巴胺和／或间羟胺，18例(85．7％)抢救成功。结论 APE年龄范围广，病因复杂多样，起病急，发展快，病死率高，快速消除APE的诱因和／或病因，尽快纠正低氧血症，及时进行气管插管和机械通气，合理应用血管活性药物和呼吸兴奋剂是抢救成功的关键。

The Clinical Features and the Treatment of Acute Pulmonary Edema in 78 Cases

Objective To sum up the clinical features and the treatment of acute pulmonary edema(APE).Methods Retrospective analysis about 78 cases with APE was done.Results (1) 56 cases were cured (71.8%), 22 cases died (28.2%). (2) 36 cases through endotracheal intubations and mechanical ventilation, 21 cases (58.3%) were cured. (3) 40 cases were used small dose morphine.32 cases (80%) were rescued, no cases presented breathing inhibition. (4) In the acute poisoning cases, 11 cases had more or less breathing inhibition, The whole cases used respiratory stimulant and opium's antagonist-naloxone,10 cases (90.9%) were cured. (5) 21 cases accompanied hypotension, were used dopamine and /or metaraminol, 18 cases were rescued (85.7%).Conclusion APE can be caused by varied causes. APE can attack all aged male or female, young or old. The causes of APE are complicated and varied. It happens fast, develops rapidly, case-fatality rate is high. Removing the cause of disease or/and predisposing cause fast, correcting hypoxemia rapidly, giving endotracheal intubation and mechanical ventilation in time, using vasoactive substance and respiratory stimulant correctly are the keys to rescue patients successfully.