Gazes P C
Department of Medicine, Medical University of South Carolina, Charleston 29425-2221.
Heart Dis Stroke. 1994 Jul-Aug;3(4):205-9.
When possible, the management of acute cardiogenic pulmonary edema should be started before the patient reaches the hospital. Simple measures such as having the patient sit up with the legs dependent, administering oxygen by nasal prongs, giving sublingual nitroglycerin and small doses of morphine, and rotating tourniquets on the limbs may reduce the need for more intensive procedures. Digoxin and other inotropic agents, aminophylline, furosemide, and vasodilators are given as appropriate during hospitalization. A minority of patients need endotracheal intubation and pressure monitoring with a Swan-Ganz catheter. If the arterial PO2 cannot be maintained at 60 mm Hg or more during face mask ventilation, the PCO2 rises, and the arterial pH declines, the patient should be intubated. Pressure monitoring with a Swan-Ganz catheter is indicated if the patient does not immediately respond to treatment or in special situations such as cardiogenic shock with pulmonary edema. Pulmonary edema caused by diastolic dysfunction is managed differently than that caused by systolic dysfunction. The cause and precipitating factors of the acute pulmonary edema should be sought and treated as early as possible to prevent recurrences.
在可能的情况下，急性心源性肺水肿的治疗应在患者到达医院之前就开始。一些简单的措施，如让患者坐起，双腿下垂，通过鼻导管吸氧，给予舌下硝酸甘油和小剂量吗啡，以及在四肢使用旋转止血带，可能会减少对更强化治疗措施的需求。住院期间酌情给予地高辛和其他强心剂、氨茶碱、呋塞米和血管扩张剂。少数患者需要气管插管并用 Swan-Ganz 导管进行压力监测。如果在面罩通气期间动脉血氧分压不能维持在 60 mmHg 或更高，二氧化碳分压升高，动脉血 pH 值下降，则应进行插管。如果患者对治疗没有立即反应或在特殊情况下，如伴有肺水肿的心源性休克，则需要用 Swan-Ganz 导管进行压力监测。舒张功能障碍引起的肺水肿与收缩功能障碍引起的肺水肿治疗方法不同。应尽早寻找并治疗急性肺水肿的病因和诱发因素，以防止复发。
