Ghofrani H A
Zentrum für Innere Medizin, Medizinische Klinik II, Universitätsklinik Giessen.
Internist (Berl). 2004 May;45(5):565-72. doi: 10.1007/s00108-004-1175-x.
An acute respiratory insufficiency as a result of pulmonary oedema is regarded as a life threatening emergency event. Diagnostic classification differentiates between cardiogenic and non-cardiogenic lung oedema. Symptomatic treatment of the impaired gas exchange often precedes a causal therapy of the underlying disease. For this purpose non-invasive ventilation, in parallel with efficient medical interventions, has come into focus. Moreover, this therapeutic intervention can prevent from the necessity of endotracheal intubation in the majority of cases. Rapid restoration of arterial oxygenation along with medical support of the cardiac function (i.e. by nitrates, diuretics, ACE-inhibitors, etc.) results in improved myocardial oxygen-delivery and reduced oxygen-consumption. This article reviews mainly the pathophysiology of cardiogenic lung edema, while most of the currently discussed therapeutic implications also apply to other entities of lung edema.
由于肺水肿导致的急性呼吸功能不全被视为危及生命的紧急事件。诊断分类可区分心源性和非心源性肺水肿。在对基础疾病进行病因治疗之前,通常先对受损的气体交换进行对症治疗。为此,非侵入性通气与有效的医学干预措施并行,已成为关注焦点。此外,这种治疗干预在大多数情况下可避免气管插管必要性。动脉氧合的快速恢复以及对心脏功能的医学支持(如使用硝酸盐、利尿剂、血管紧张素转换酶抑制剂等)可改善心肌氧输送并减少氧消耗。本文主要综述心源性肺水肿的病理生理学,而目前讨论的大多数治疗意义也适用于其他类型的肺水肿。