Hasibeder Walter R
Division of General and Surgical Intensive Care Medicine, Department of Anaesthesia and Critical Care Medicine, The Leopold Franzens University of Innsbruck, Innsbruck, Austria.
Curr Opin Anaesthesiol. 2003 Apr;16(2):139-45. doi: 10.1097/00001503-200304000-00006.
To summarize current knowledge on pathophysiology and treatment of drowning accidents. Studies and case reports were searched using the keywords drowning, near-drowning, asphyxia, hypoxia and hypothermia in conjunction with organ systems and specific treatment options.
Drowning is defined as death by suffocation in a liquid. In contrast, near-drowning is defined as survival beyond 24 h after a drowning accident. Drowning is a frequent preventable accident with a significant morbidity and mortality in a mostly healthy population. In the majority of patients the primary injury is pulmonary, resulting in severe arterial hypoxemia and secondary damage to other organs. Damage to the central nervous system is most critical in terms of patient survival and subsequent quality of life. Therefore, prompt resuscitation and aggressive respiratory and cardiovascular treatment are crucial for optimal survival. Immediate interruption of hypoxia, aggressive treatment of hypothermia and cardiovascular failure are the cornerstones of correct medical treatment. Unfortunately, accurate neurologic prognosis cannot be predicted from initial clinical presentation, laboratory, radiological or electrophysiological examinations.
Several case studies have convincingly demonstrated that drowning victims may survive neurologically intact even after prolonged submersion times, in particular in cold water. Therefore, aggressive initial therapeutic efforts are indicated in most near-drowning victims.
总结当前关于溺水事故病理生理学及治疗的知识。使用关键词“溺水”“近乎溺水”“窒息”“缺氧”和“体温过低”，结合器官系统及具体治疗方案，检索相关研究和病例报告。
溺水被定义为在液体中因窒息而死亡。相比之下，近乎溺水被定义为溺水事故后存活超过24小时。溺水是一种常见的可预防事故，在大多健康人群中具有显著的发病率和死亡率。在大多数患者中，主要损伤是肺部的，导致严重的动脉低氧血症及对其他器官的继发性损害。就患者存活及随后的生活质量而言，中枢神经系统的损伤最为关键。因此，迅速复苏以及积极的呼吸和心血管治疗对于最佳存活至关重要。立即中断缺氧、积极治疗体温过低和心血管衰竭是正确医疗的基石。不幸的是，无法根据初始临床表现、实验室、放射学或电生理检查来预测准确的神经学预后。
多项病例研究令人信服地表明，溺水受害者即使在长时间浸没后也可能在神经功能上完好地存活下来，尤其是在冷水中。因此，对于大多数近乎溺水的受害者，应进行积极的初始治疗努力。
