危重地震傷患者發生急性肺水腫危險因素及處理策略_《中國呼吸與危重監護雜志》

作者：

鄧一蕓 , 廖雪蓮 , 王波 ,  康焰 , 王嵐 , 楊嶺 , 王存真 , 蒲虹

四川大學華西醫院ICU(四川成都 610041);

關鍵詞：

地震急性肺水腫危險因素

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目的回顧性分析5·12大地震后四川大學華西醫院ICU收治的地震傷患者發生急性肺水腫(APE)的危險因素以及處理策略，為臨床實踐提供參考。方法收集數據包括：在四川大學華西醫院ICU住院治療期間APE患者的血紅蛋白水平、血清白蛋白水平、平均動脈壓(MAP)和中心靜脈壓(CVP)，合并癥，發生前1周、3 d以及1 d液體平衡情況等。對發生APE的危險因素進行分析，并總結對該組患者的處理策略以及治療效果。結果在地震發生后2個月內142例患者中共有17例發生25次APE，其中肢體殘缺11例(64．7％)。在發生APE時患者血紅蛋白為(86．04±16．31)g／L，MAP為(99．40±17．38)mm Hg，CVP為(13．64 ±4．09)mm Hg，血清白蛋白水平為(27．80±8．10)g／L。合并急性腎功能障礙16例(94．1％)，嚴重感染13例(76．5％)，心臟基礎疾病3例(17．6％)。發生前1周液體凈入量為(1 725．05±4 624．84)mL；前3 d液體凈入量為(1 574．70±2 857．13)mL；前1 d液體凈入量為(368．56±1 589．89)mL。年輕患者輸液量明顯高于老年患者(P lt;0．05)。經限液、利尿、擴冠、強心、呼吸支持及藥物處理后，患者APE均在短期內得到控制。結論合并急性腎功能障礙或肢體殘缺的創傷患者在并發感染或液體超負荷的情況下，易發生APE。及時發現綜合處理可收到良好效果。

引用本文： 鄧一蕓,廖雪蓮,王波,康焰,王嵐,楊嶺,王存真,蒲虹. 危重地震傷患者發生急性肺水腫危險因素及處理策略. 中國呼吸與危重監護雜志, 2008, 08(4): 248-252. doi: 復制

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5.	Harvey S, Harrison DA, Singer M, et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet, 2005, 366:472-477.
6.	Khan H, Belsher J, Yilmaz M, et al. Fresh-Frozen Plasma and Platelet Transfusions Are Associated With Development of Acute Lung Injury in Critically Ill Medical Patients. Chest Am College Chest Physi,2007, 131:1308-1314.
7.	Wiedemann HP，Wheeler AP，Hayden D. Comparison of Two Fluid-Management Strategies in Acute Lung Injury. NEJM, 2006,354: 2564-2575.
8.	Rivers EP. Fluid-Management Strategies in Acute Lung Injury - Liberal, Conservative, or Both?NEJM,2006,354: 2598-2600.
9.	Park M, Sangean MC, Volpe Mde S. Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema. Crit Care Med,2004,32: 2407-2415.
10.	Park M, Lorenzi-Filho G. Noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema. Clinics,2006; 61: 247-252.
11.	Brower RG, Ware LB, Berthiaume Y, et al. Treatment of ARDS. Chest. 2001, 120: 1347-1367.
12.	Aberle DR, Wiener-Kronish JP, Webb WR, et al. Hydrostatic versus increased permeability pulmonary edema: diagnosis based on radiographic criteria in critically ill patients. Radiology, 1988, 168: 73–79.
13.	Roberto C, Gino S, Paolo C. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound, 2008, 6: 16-19.
14.	Dimitri K, Ajay JK, Christopher PR. Diagnostic and Prognostic Utility of Brain Natriuretic Peptide in Subjects Admitted to the ICU With Hypoxic Respiratory Failure Due to Noncardiogenic and Cardiogenic Pulmonary Edema. Chest. 2007, 131: 964-971.
15.	Bentancur A, Rieck J, Koldanov R, et al. Acute Pulmonary Edema in the Emergency Department: Clinical and Echocardiographic Survey in an Aged Population. Am J Med Sci,2002,323:238-243.
16.	王建昌，劉平，陳力達，等.老年人和中青年人首發急性左心衰誘因和病因的對比研究.中國老年學雜志，2006,26：1607-1608.

1. Gheorghiade M, Zannad F, Sopko G, et al. Acute Heart Failure Syndromes: Current State and Framework for Future Research. Circulation, 2005,112: 3958-3968.
2. Demling RH, LaLonde C, Ikegami K. Pulmonary edema: pathophysiology, methods of measurement, and clinical importance in acute respiratory failure. New Horiz, 1993, 1:371-380.
3. Faubel S. Pulmonary complications after acute kidney injury. Adv Chronic Kidney Dis, 2008, 15:284-296.
4. Mangialardi RJ, Martin GS, Bernard GR,et al. Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis. Ibuprofen in Sepsis Study Group. Crit Care Med, 2000,28:3137–3145.
5. Harvey S, Harrison DA, Singer M, et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial. Lancet, 2005, 366:472-477.
6. Khan H, Belsher J, Yilmaz M, et al. Fresh-Frozen Plasma and Platelet Transfusions Are Associated With Development of Acute Lung Injury in Critically Ill Medical Patients. Chest Am College Chest Physi,2007, 131:1308-1314.
7. Wiedemann HP，Wheeler AP，Hayden D. Comparison of Two Fluid-Management Strategies in Acute Lung Injury. NEJM, 2006,354: 2564-2575.
8. Rivers EP. Fluid-Management Strategies in Acute Lung Injury - Liberal, Conservative, or Both?NEJM,2006,354: 2598-2600.
9. Park M, Sangean MC, Volpe Mde S. Randomized, prospective trial of oxygen, continuous positive airway pressure, and bilevel positive airway pressure by face mask in acute cardiogenic pulmonary edema. Crit Care Med,2004,32: 2407-2415.
10. Park M, Lorenzi-Filho G. Noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema. Clinics,2006; 61: 247-252.
11. Brower RG, Ware LB, Berthiaume Y, et al. Treatment of ARDS. Chest. 2001, 120: 1347-1367.
12. Aberle DR, Wiener-Kronish JP, Webb WR, et al. Hydrostatic versus increased permeability pulmonary edema: diagnosis based on radiographic criteria in critically ill patients. Radiology, 1988, 168: 73–79.
13. Roberto C, Gino S, Paolo C. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound, 2008, 6: 16-19.
14. Dimitri K, Ajay JK, Christopher PR. Diagnostic and Prognostic Utility of Brain Natriuretic Peptide in Subjects Admitted to the ICU With Hypoxic Respiratory Failure Due to Noncardiogenic and Cardiogenic Pulmonary Edema. Chest. 2007, 131: 964-971.
15. Bentancur A, Rieck J, Koldanov R, et al. Acute Pulmonary Edema in the Emergency Department: Clinical and Echocardiographic Survey in an Aged Population. Am J Med Sci,2002,323:238-243.
16. 王建昌，劉平，陳力達，等.老年人和中青年人首發急性左心衰誘因和病因的對比研究.中國老年學雜志，2006,26：1607-1608.

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《中國呼吸與危重監護雜志》

危重地震傷患者發生急性肺水腫危險因素及處理策略

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