蜘網膜下腔出血引發神經性肺水腫－急診病例報告暨文獻回顧

Neurogenic Pulmonary Edema Associated with Subarachnoid Hemorrhage: An Emergency Case Report and Review of the Literature

陳穎信(Ying-Hsin Chen) ； 林健盛(Chien-Sheng Lin) ； 藍國徵(Kuo-Cheng Lan) ； 劉敏英(Ming-Ying Liu)

《Journal of Medical Sciences》 19卷4期 (1999/02) Pp. 232-239

摘要

急性肺水腫是急診常見而且危急的問題，大部份的原因是由心臟方面引起。而由中樞神經系統受創（GNS insults）如蛛網膜下腔出血、顱內出血、大發作抽搐及頭部外傷等所引發之肺水腫稱為神經性肺水腫（neurogenic pulmonary edema），在臨床上較少見。致病機轉目前尚未清楚，可能導源於中樞神經系統受創後引發大量交感神經興奮，及全身性之血管收縮所致。我們提出一急診病例由於蛛網膜下腔出血引發神經性肺水腫，並就其致病機轉、臨床表現、急診處理及心電圖變化提出討論，並作一文獻回顧。

關鍵字

中樞神經系統受創 ； 神經性肺水腫 ； 蛛網膜下腔出血

並列摘要

Acute pulmonary edema is a common and critical problem in the emergency department, most of the causes is resulted from cardiac origin. The pulmonary edema following a central nervous system insults such as subarachnoid hemorrhage, intracranial bleeds, grand mal seizures and isolated head trauma is called neurogenic pulmonary edema, which is less common clinically. Pathogenesis is not clear now, probably results from massive sympathetic discharge and generalized vasoconstriction after central nervous system insults. We report a emergency case of neurogenic pulmonary edema secondary to subarachnoid hemorrhage, and review its pathogenesis, clinical presentation, emergent management and electrocardiographic changes.

並列關鍵字

central nervous system insults ； neurogenic pulmonary edema ； subarachnoid hemorrhage