Deehan S C, Grant I S
Intensive Therapy Unit, Western General Hospital Edinburgh, UK.
Intensive Care Med. 1996 Jul;22(7):672-6. doi: 10.1007/BF01709745.
The haemodynamic and gas exchange abnormalities occurring in neurogenic pulmonary oedema (NPO) were examined retrospectively in 20 patients admitted to the Intensive Therapy Unit (ITU) over a 45-month period (February 1992 to November 1995). In 12 patients, where vasoactive therapy with dobutamine was employed, its effect on haemodynamics was examined. Cardiac index (CI median 2.2 l min-1 m-2) and left ventricular stroke work index (LVSWI 20 g.m.m-2) were markedly depressed, while pulmonary artery wedge pressure (PAWP 17 mmHg), mean pulmonary artery pressure (MPAP 30.5 mmHg), systemic vascular resistance index (SVRI 2852 dyne.s.cm-5.m2) and pulmonary vascular resistance index (PVRI 393 dyne.s.cm-5.m2) were substantially elevated above normal values. Mean arterial pressure (MAP 82.5 mmHg) and heart rate (HR 102 bpm) were within normal limits. The poor oxygenation is indicated by a median PaO2/fiO2 ratio of 18.0 kPa. Patients treated with dobutamine showed significant increases in CI and LVSWI and significant falls in SVRI and PAWP at 2 and 6 h after institution of therapy, and there was a significant rise in PaO2/fiO2 ratio to 27.8 kPa at 6 h. NPO was generally associated with severe depression of myocardial function and elevation of pulmonary vascular pressures. This dysfunction was readily reversed by dobutamine.
在45个月期间（1992年2月至1995年11月），对入住重症监护病房（ITU）的20例患者的神经源性肺水肿（NPO）所发生的血流动力学和气体交换异常进行了回顾性研究。在12例使用多巴酚丁胺进行血管活性治疗的患者中，研究了其对血流动力学的影响。心脏指数（CI中位数为2.2升/分钟/平方米）和左心室每搏功指数（LVSWI为20克·米/平方米）明显降低，而肺动脉楔压（PAWP为17 mmHg）、平均肺动脉压（MPAP为30.5 mmHg）、全身血管阻力指数（SVRI为2852达因·秒/厘米⁻⁵·平方米）和肺血管阻力指数（PVRI为393达因·秒/厘米⁻⁵·平方米）均大幅高于正常值。平均动脉压（MAP为82.5 mmHg）和心率（HR为102次/分钟）在正常范围内。氧合不佳表现为PaO₂/FiO₂比值中位数为18.0 kPa。接受多巴酚丁胺治疗的患者在治疗开始后2小时和6小时时，CI和LVSWI显著增加，SVRI和PAWP显著下降，且在6小时时PaO₂/FiO₂比值显著升至27.8 kPa。NPO通常与心肌功能严重抑制和肺血管压力升高有关。这种功能障碍可通过多巴酚丁胺轻易逆转。
