危重地震伤患者发生急性肺水肿危险因素及处理策略
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摘要
目的回顾性分析5.12大地震后四川大学华西医院ICU收治的地震伤患者发生急性肺水肿(APE)的危险因素以及处理策略,为临床实践提供参考。方法收集数据包括:在四川大学华西医院ICU住院治疗期间APE患者的血红蛋白水平、血清白蛋白水平、平均动脉压(MAP)和中心静脉压(CVP),合并症,发生前1周、3d以及1d液体平衡情况等。对发生APE的危险因素进行分析,并总结对该组患者的处理策略以及治疗效果。结果在地震发生后2个月内142例患者中共有17例发生25次APE,其中肢体残缺11例(64.7%)。在发生APE时患者血红蛋白为(86.04±16.31)g/L,MAP为(99.40±17.38)mmHg,CVP为(13.64±4.09)mmHg,血清白蛋白水平为(27.80±8.10)g/L。合并急性肾功能障碍16例(94.1%),严重感染13例(76.5%),心脏基础疾病3例(17.6%)。发生前1周液体净入量为(1725.05±4624.84)mL;前3d液体净入量为(1574.70±2857.13)mL;前1d液体净入量为(368.56±1589.89)mL。年轻患者输液量明显高于老年患者(P<0.05)。经限液、利尿、扩冠、强心、呼吸支持及药物处理后,患者APE均在短期内得到控制。结论合并急性肾功能障碍或肢体残缺的创伤患者在并发感染或液体超负荷的情况下,易发生APE。及时发现综合处理可收到良好效果。
Objective To analyze risk factors and therapy strategies of critically ill patients with acute pulmonary edema(APE)after the 2008 Wenchuan earthquake.Methods Data including the level of hemoglobin,mean arterial pressure(MAP),central venous pressure(CVP),serum albumin as well as complications and liquid balance 1 week,3 days,1 day before onset of APE was collected and analyzed retrospectively.Results Among 142 patients during two months after May 12 earthquake APE was detected in 17 cases for 25 times.The hemoglobin was(86.04±16.31)g/L,MAP was(99.40±17.38)mm Hg,CVP was(13.64±4.09)mm Hg and serum albumin was(27.80±8.10)g/L.Acute renal failure,severe infection,cardiovascular disease and extremity lost were more common in APE patients.The liquid net intake was(1 725.05±4 624.84)mL for one week,(1 574.70±2 857.13)mL for 3 days and(368.56±1 589.89)mL for 1 day before the onset of APE.The liquid intake was significantly higher in young group.APE was alleviated promptly after integrated therapy in all cases.Conclusions Trauma patients with ARF or extremity lost are prone to be compromised with APE.Severe infection and overburden of liquid may be other predisposing factors.
引文
1Gheorghiade M,Zannad F,Sopko G,et al.Acute Heart Fail-ure Syndromes:Current State and Framework for Future Re-search.Circulation,2005,112:3958-3968.
    2Demling RH,LaLonde C,Ikegami K.Pulmonary edema:pathophysiology,methods of measurement,and clinical im-portance in acute respiratory failure.New Horiz,1993,1:371-380.
    3Faubel S.Pulmonary complications after acute kidney inju-ry.Adv Chronic Kidney Dis,2008,15:284-296.
    4Mangialardi RJ,Martin GS,Bernard GR,et al.Hypopro-teinemia predicts acute respiratory distress syndrome devel-opment,weight gain,and death in patients with sepsis.Ibu-profen in Sepsis Study Group.Crit Care Med,2000,28:3137-3145.
    5Harvey S,Harrison DA,Singer M,et al.Assessment of the clinical effectiveness of pulmonary artery catheters in man-agement of patients in intensive care(PAC-Man):a ran-domised controlled trial.Lancet,2005,366:472-477.
    6Khan 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.
    7Wiedemann HP,Wheeler AP,Hayden D.Comparison of Two Fluid-Management Strategies in Acute Lung Injury.NEJM,2006,354:2564-2575.
    8Rivers EP.Fluid-Management Strategies in Acute Lung In-jury-Liberal,Conservative,or Both-NEJM,2006,354:2598-2600.
    9Park M,Sangean MC,Volpe Mde S.Randomized,prospec-tive trial of oxygen,continuous positive airway pressure,and bilevel positive airway pressure by face mask in acute car-diogenic pulmonary edema.Crit Care Med,2004,32:2407-2415.
    10Park M,Lorenzi-Filho G.Noninvasive mechanical ventila-tion in the treatment of acute cardiogenic pulmonary edema.Clinics,2006,61:247-252.
    11Brower RG,Ware LB,Berthiaume Y,et al.Treatment of ARDS.Chest,2001,120:1347-1367.
    12Aberle DR,Wiener-Kronish JP,Webb WR,et al.Hydrostat-ic versus increased permeability pulmonary edema:diagno-sis based on radiographic criteria in critically ill patients.Radiology,1988,168:73-79.
    13Roberto 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.
    14Dimitri K,Ajay JK,Christopher PR.Diagnostic and Prog-nostic Utility of Brain Natriuretic Peptide in Subjects Ad-mitted to the ICU With Hypoxic Respiratory Failure Due to Noncardiogenic and Cardiogenic Pulmonary Edema.Chest,2007,131:964-971.
    15Bentancur A,Rieck J,Koldanov R,et al.Acute Pulmonary Edema in the Emergency Department:Clinical and Echocar-diographic Survey in an Aged Population.Am J Med Sci,2002,323:238-243.
    16王建昌,刘平,陈力达,等.老年人和中青年人首发急性左心衰诱因和病因的对比研究.中国老年学杂志,2006,26:1607-1608.

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