神經性肺水腫：五病例報告

Neurogenic Pulmonary Edema: Five Cases Report

林忠男(Chung-Nan Lin) ； 洪純隆(Shen-Long Howng) ； 郭泰宏(Tai-Hong Kuo) ； 黃旭霖(Shiuh-Lin Hwang) ； 高英隆(Eing-Long Kao)

《The Kaohsiung Journal of Medical Sciences》 8卷9期 (1992/09) Pp. 510-519

https://doi.org/10.6452/KJMS.199209.0510

摘要

本文報告五例中樞神經系統傷害引起之神經性肺水腫(neurogenic pulmonary edema, NPE)。其中四例為頭部外傷，另一例則為罕見之三叉神經痛開腦術後造成。傷害後至發生NPE的時間不一定。由三小時至四天。症狀以突發性咳嗽、呼吸困難、心跳加速、發紺、意識不清及泡沫狀血痰表現為多。肺部X光證實有單、雙側之局部或散在性病灶。治療主要包括藥物的使用如利尿劑(furosemide, mannitol)，降腦壓劑(glycerol)，麻醉劑(morphine, Phenobarbital)，交感神經抑制及血管擴張藥物(hydralazine, sodium nitroprusside)，以及利用人工呼吸器CPU-1加上呼氣末期正壓性呼吸(PEEP, ＋5－10cm H2O)來輔助治療。治療後其中有四例肺部之臨床症狀及X光追蹤顯示病情在24至48小時內皆有改善，但僅有一頭部外傷例存活。本文強調中樞神經系統外傷或手術後之呼吸困難需考慮NPE可能性，而此種肺功能障礙對治療的反應良好。

並列摘要

Five patients with neurogenic pul-monary edema (NPE) were reported, The edemas were caused by head injuries in four patients and by a craniotomy in the fifth. The onset of NPE was either acute (3 hours after injuries in four patients and by a craniotomy in the fifth. The onset of NPE was slow to develop (4 days later). Clinical symptoms included the sudden soset of coughing, tachypnea, tachycardia, and pink bubbly sputum. Moreover, the patients also suffered cyanosis, confusion, or respiratory fail-ure. The distribution of the resulting pulmonary edema was diffuse in 4 cases and localized within a single lobe of the lung in 1 case. Treatment of the NPE included reducing intracranial pressure (glycerol). diuresis (furosemide and mannitol), and blocking the peripheral effect of symptathetic reflex activity (hydralazine, sodium nitroprusside). Mechanical ventilation support (CPU-1) in combination with controlled hyperventilation may also be necessary. The inability to correct hypoxemia without toxic levels of oxygen necessi-tates the use of PEEP (positive and-ex-piratory pressure, +5-10cm H2O). Reso-lution of symptoms was noted 24 to 48 hours after treatment in 4 patients. Ear-ly diagnosis and intensive care of the pulmonary edema may have a signifi-cant bearing on the recovery of lung functions, Unfortunately, 4 of the pa-tients failed to survive vecause of cen-tral nervous system failure. We therefore want to emphasize that NPE can cause secondary deterioration of neurological functions. In conclusion, when dealing with respiratory distress patients with CNS injuries, the possiility of additional damage from a NPE must be taken into consideration.

並列關鍵字

neurogenic pulmonary edema(NPE) ； CNS jnjury ； PEEP