Blanloeil Y, Baron D, de Lajartre A Y, Nicolas F
Sem Hop. 1980;56(21-24):1088-90.
Non hemodynamic pulmonary edemas included by some authors in the acute respiratory distress syndrome (ARDS) had been reported in cerebral malaria. We describe a new case. Clinical data, hemodynamic studies with PWP measurement, and anatomic findings are coherent with the diagnosis of ARDS. Although the underlying causal mechanisms--the marked parasitemia and its consequence on permeability of the pulmonary capillary--remain speculative, they seem credible. The pulmonary lesions are provoked by these main factors and worsened by hypoprotidemia and surinfection. Prevention of all these factors can stop the evolution towards refractory hypoxemia but the precocity of quinine treatment remains the most important point.
一些作者将非血流动力学性肺水肿纳入急性呼吸窘迫综合征(ARDS),脑型疟疾中也曾有过相关报道。我们描述了一个新病例。临床数据、通过测量肺毛细血管楔压(PWP)进行的血流动力学研究以及解剖学发现均与ARDS的诊断相符。尽管潜在的因果机制——显著的寄生虫血症及其对肺毛细血管通透性的影响——仍属推测,但似乎可信。肺部病变由这些主要因素引发,并因低蛋白血症和重叠感染而加重。预防所有这些因素可阻止病情发展为难治性低氧血症,但奎宁治疗的及时性仍是最重要的一点。