Abdennour L, Zeghal C, Dème M, Puybasset L
Réanimation neurochirurgicale, unité de neuroanesthésie-réanimation, département d'anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de L'Hôpital, 75013 Paris, France.
Ann Fr Anesth Reanim. 2012 Jun;31(6):e101-7. doi: 10.1016/j.annfar.2012.04.013. Epub 2012 Jun 12.
The brain and the lungs interact early and rapidly when hit by a disease process. Often well tolerated by the healthy brain, an impaired respiratory function may deteriorate further a "sick" brain. Hypoxemia is a prognostic factor in the brain-injured patients. At the opposite, an acute brain damage early impacts the lung function. Local brain inflammation spreads rapidly to the lung. It initiates an immunological process weakening the lungs and increasing its susceptibility to infection and mechanical ventilation. Sometimes this process is preceded by a swelling lesion, known as neurogenic pulmonary oedema, resulting from an sympathetic overstimulation which usually follows an intense and brutal surge of intracranial pressure. The management of brain-injured patients has to be directed toward the protection of both the brain and lung. Neuronal preservation is crucial, because of the lack of regenerative potential in the brain, unlike the lung. A compromise must be obtained between the cerebral and pulmonary treatments although they may conflict in some situations.
当受到疾病进程影响时，大脑和肺部会早期且迅速地相互作用。呼吸功能受损通常能被健康的大脑较好地耐受，但可能会使“患病”大脑进一步恶化。低氧血症是脑损伤患者的一个预后因素。相反，急性脑损伤会早期影响肺功能。局部脑炎症会迅速蔓延至肺部。它引发一个免疫过程，削弱肺部并增加其对感染和机械通气的易感性。有时这个过程之前会出现一个肿胀病变，称为神经源性肺水肿，它是由通常在颅内压急剧剧烈升高后发生的交感神经过度刺激引起的。脑损伤患者的治疗必须旨在保护大脑和肺部。由于大脑缺乏再生潜能，与肺部不同，神经元的保存至关重要。尽管在某些情况下脑和肺的治疗可能相互冲突，但必须在两者之间取得平衡。
