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高原肺水患者心理状态测评
高原肺水肿(high altitude pulmonary edema,HAPE)是高原急危重病症之一,由于运输条件的改善,从低海拔地区急进高原的人数增多,患高原适应不全的人数较以往增多[1].高原环境对人们的生理、心理均产生多方面的影响.本文对在我院(海拔3600m)确诊为HAPE的住院患者采用HAMD量表[2]进行了测定,其中男性1 24例,女性28例,平均年龄26.53±8.41岁.
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急性脑血管病并神经源性肺水肿14例临床分析
神经源性肺水肿(neurogenic pulmonary edema,NPE)是继发于各种中枢神经系统损伤所致的突发性颅内压增高引起的急性肺水肿,而无原发性心、肺、肾等疾病[1].本文就1995年～1998年6月收治的急性脑血管病并NPE 14例进行临床分析,总结其诊治体会.现报道如下.
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急性高原肺水肿的救治
急性高原肺水肿(high altitude pulmonary edema,HAPE)为高原病中的常见急症,重者可能致命,目前其发病机制不清.有研究认为其与体内血管活性物质比例失衡有关[1].本研究测定HAPE组与平原、高原健康人血中与低氧相关的血管活性因子NO、VEGF、ET-1水平,探讨血管活性因子变化与HAPE发病的关系.
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急性呼吸窘迫综合征的生物标志物研究进展
急性呼吸窘迫综合征（ ARDS）是一种急性肺部炎症损伤性疾病，以肺泡-毛细血管膜损伤导致通透性升高，引起肺间质和肺泡水肿，肺泡塌陷和气体交换障碍为特征，临床表现为顽固性低氧血症、进行性呼吸窘迫和非心源性肺水肿。 ARDS病死率极高，约27％～45％。为了提高ARDS诊断的特异度，2012年美国医学协会杂志出版了修订后的定义，但是修订后的定义没有采用新的生物标志物或参数。随着对ARDS病理生理学认识的进展，炎症反应引起的各种体液因素和来自损伤组织或活化的细胞的分子将可能成为应用于临床实践的潜在生物标志物。本文对ARDS潜在的标志物进行综述。
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儿童重症颅内高压合并神经源性肺水肿2例分析
神经源性肺水肿(neurogenic pulmonary edema,NPE)是重症脑部疾患和损伤的一种严重并发症.起病迅速,治疗困难,预后不良.本病在儿科报道较少[1],为提高对本病的认识,现报道2例儿童NPE如下.
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肺切除术后肺水肿与围手术期用药
早在1984年,Zeldin首次提出"全肺切除术后肺水肿(post pneumonectomy pulmonary edema,PPE)"的概念[1].此后文献报道PPE的发生率为5%～15%,病死率50%～100%,肺叶切除亦可出现类似PPE的病生理改变,发生率约1%～7%[2].可见这一类并发症在肺脏手术并不罕见,对患者的健康和生命造成极大威胁.
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高原肺水肿患者心理状况及护理对策
高原肺水肿(High Altitude Pulmonary Edema,HAPE)是高原疾病中危及生命的急、重病症之一.由于运输条件的改善,从低海拔地区急速进入高原的人数增多,患高原适应不全及HAPE的人数较以往增多.[1]我们通过对165例HAPE患者因社会及身心因素而产生的焦虑、抑郁情绪进行分析,探讨在常规护理基础上心理护理的对策 ,以提高对HAPE患者的治疗与护理质量.
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Pickering综合征研究进展
Pickering综合征是指双侧肾动脉狭窄(或孤立肾的单侧肾动脉狭窄)合并一过性肺水肿(flash pulmonary edema,FPE)的一类临床综合征,因Pickering在1988年首先报道了该类病例,Messerli遂将此类综合征命名为Pickering综合征[1].临床上,FPE通常用来描述急性失代偿性心力衰竭变化比较剧烈的一种特殊的类型,但肾动脉狭窄所致的FPE与急性失代偿性心力衰竭在病理生理机制和治疗方式等方面存在很大的差异性.本文从流行病学、临床表现、发病机制和临床治疗四个方面阐述Pickering综合征研究新进展.
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重症复张性肺水肿一例并文献复习
复张性肺水肿（reexpansion pulmonary edema， RPE）是指继发于各种原因所致的萎陷性肺迅速复张时所发生的急性非心源性肺水肿，多见于气胸或胸腔积液患者大量排气、排液后。RPE起病急、病情重，如发现治疗不及时，会使病情急剧恶化，甚至死亡。目前胸穿抽气和抽液在临床上广泛运用，故提高本病的认识很有必要。我科成功救治了1例重症RPE合并休克的患者，现根据病例并复习有关文献分析报道如下。
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肺水肿的再认识
肺水肿为内科危急重症,临床症状凶险、变化快、病死率极高.近年来对心源性肺水肿的认识有了新的探索.肺水肿是一个综合征,包括由心功能不全(收缩和/或舒张功能不全)引起的肺静脉高压致心源性肺水肿(cardiogenic pulmonary edema)和由于多种心外病因所致肺毛细血管通透性改变,肺血容量过高,血浆渗透压过低,淋巴回流障碍等原因所致的非心源性肺水肿(noncardiogenic pulmonary edema).
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6例复张性肺水肿的诊治
复张性肺水肿(reexpansion pulmonary edema,RPE)是一种少见的、继发于任何原因所致的肺不张后肺复张时或复张后发生的急性肺水肿.1980年1月至2004年6月,我们诊治6例,现报道如下.
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复张性肺水肿的临床研究
复张性肺水肿(reexpansion pulmonary edema,REPE) 是指任何原因导致的肺不张,在肺复张时或复张后发生的急性肺水肿.
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小儿神经源性肺水肿
神经源性肺水肿(neurogenic pulmonary edema,NPE)是指在无原发性心、肺和肾等疾病的情况下,由颅脑损伤或中枢神经系统(central nervous system,CNS)其他疾病引起的突发性颅内压增高而导致的急性肺水肿[1],称中枢性肺水肿.
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挤压综合征急性肾功能衰竭肺水肿
第一次查房主治医师,入ICU后3 h内.住院医师汇报病史.患儿,男,10岁.因"5.12"地震压伤后16 d,水肿、少尿14 d入院.地震时患儿被水泥板压盖,2 h后获救.当地医院检查发现左下肢伤痕和左耻骨骨折.2 d后出现少尿、水肿、血肌酐(Cr)和尿素(BUN)升高,考虑挤压综合征.因急性肾功能衰竭(急性肾衰)进行间断性血液透析等治疗14 d,全身水肿减轻,但左下肢肿胀仍明显.
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肠道病毒71型感染首发肺水肿与肺出血三例报告
Objective To investigate the clinical features of the enterovirus 71 ( EV71 ) infection complicated with pulmonary edema or pulmonary hemorrhage as a fulminant and often fatal illness.Methods The medical records of three cases with EV71 infection were retrospectively reviewed for clinical manifestations, laboratory data, medications, and outcome.Results All the cases were infants and died of the infection. These infants had no skin or mucosal lesions, however, they had sudden onset of cyanosis and tachypnea 1 to 2 days after the onset of the febrile disease with vomiting. All these 3 cases were misdiagnosed and were treated for shock on admission. Pulmonary hemorrhage was not considered in any of the cases on admission. All the cases received tracheal intubation when foamy secretions were discharged from the mouth and nose of the patients and notable cyanosis occurred. After intubation, pink foamy fluid flew out from the endotracheal tube in all the 3 cases. The patients had hyperglycemia and limb weakness, two had tachycardia, and hypertension was found in one case. Chest X-ray showed bilateral or unilateral widespread air space opacity, but the cardiac size and shape were normal. All the patients had leukocytosis. Enterovirus 71 infection was confirmed by detection of specific nucleic acid sequences of the virus from throat swab and tracheal secretions samples and in one case in cerebrospinal fluid.Conclusions Pulmonary edema or pulmonary hemorrhage occurred in the 3 cases with EV71 infection. The initial presentation was nonspecific with fever and vomiting, and sudden appearance of cyanosis, tachypnea, tachycardia, hypertension or hypotension, limb weakness, which may suggest pulmonary edema or hemorrhage. Excessive fluid resuscitation may deteriorate the illness, on the contrary, fluid restriction and inotropic agents, and early intubation with positive pressure mechanical ventilation may be the proper treatment.
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儿童挤压综合征并肺水肿二例
2008年5月28日,我院收治汶川地震的严重挤压伤患儿8例,其中2例发生急性肾功能衰竭,1例尚有骨折.现将2例挤压综合征(crush syndrome,CS)、急性肾功能衰竭合并肺水肿病例报道如下.
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肠道病毒71型所致急性肺水肿机制研究进展
手足口病是一种主要表现为手、足、口腔等部位的斑丘疹、疱疹的急性传染病,大多呈良性临床过程,但少数病例可出现脑膜炎、脑炎、脑脊髓炎、肺水肿、循环障碍等重型、危重型表现,肠道病毒71型(EV71)是这类病例的主要病原,继发于脑干脑炎的急性肺水肿是危重患儿的重要致死原因[1],通常被认为是神经源性的,称为神经源性肺水肿( neurogenic pulmonary edema,NPE),但急性左心衰、细胞因子释放与血管通透性增加等因素亦在肺水肿的形成和进展中发挥了作用.目前,有关EV71所致急性肺水肿机制尚不明确,现就其研究进展综述如下.
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肠道病毒71型感染所致危重症手足口病诊治中的一些思考
肠道病毒71型( EV71)感染所致的儿童手足口病(hand foot mouth disease,HFMD)和疱疹性咽峡炎(herpangina)已经成为疾病预防控制系统和儿科医师,尤其是儿童重症医学专科医师都需要面对的重要问题,该病每年4至7月间在全国各地发生,并造成多例婴幼儿死亡.EV71感染后神经系统并发症比例特别高,脑干脑炎与脑疝致交感神经相对亢奋,导致神经源性肺水肿(neurogenic pulmonary edema,NPE)、循环功能衰竭.我国卫生部已经发布了相关指南或共识,但无论机制还是治疗方案仍然存在诸多争议.
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神经源性肺水肿
Neurogenic pulmonary edema (NPE) is a type of pulmonary edema that occurs secondary to central nervous sytem (CNS) damage, namely centrogenic pulmonary edema or cerebrogenic pulmonary edema[1,2] NPE is clinically characterized by acute dyspnea and progressive hypoxemia, while tachycardia, hypertension and tachypnea are only nonspecific symptoms in early phase. Early diagnosis of NPE is difficult since chest X-ray shows no remarkable sign or only increased hazy lung markings in early stage[3]. Diagnosis can be made definitely in the late stage of NPE according to the following manifestation : paleness, clamminess, feeling of impending death, rales, frothy pink sputum, hypoxemia and bilateral widespread infiltration on chest roentgenography. However, successful rescue rate is very low and mortality rate could reach as high as 90% at this stage[4-6].
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神经源性肺水肿
神经源性肺水肿(neurogenic pulmonary edema,NPE)是指无心、肺、肾等疾病的情况下,由于中枢神经系统(CNS)损伤导致的急性肺水肿,又称"中枢性肺水肿"或"脑源性肺水肿"[1,2].
