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[非血流动力学肺水肿的严重程度因素及诊断]

[Severity factors and diagnosis of nonhemodynamic pulmonary edemas].

作者信息

Chevais R, Erny P

出版信息

Ann Anesthesiol Fr. 1975;16 Spec No 2-3:179-88.

PMID:9864
Abstract

This syndrome is characterised by changes in the pulmonary capillary bed allowing filtration of edema fluid rich in proteins. It provokes an alveolo-capillary block and a fall in compliance. Positive diagnosis is envisaged from the clinical circumstances implicating a change in the pulmonary capillaries (blast, shock, microemboli). The fall in pO2 is early and intense. The fall in compliance is later and leads to hypoventilation necessitating ventilatory assistance. Diffuse radiological opacification of both pulmonary fields is characteristics, in its appearance and also in its prolonged course. In the differential diagnosis one should try to eliminate acute pulmonary edema and refractory hypoxia of bronchogenic origin. Prognosis of the condition is fixed by the course (of the pO2, of possible hypoventilation, of the radiological pictures), under treatment. Although persistance of the syndrome for more than one or two weeks is of bad prognosis, cases have been known to progress for more than three weeks and to heal leaving no after-effects. The syndrome can be complicated by cardiac incompetence, organic renal failure, which again aggravate the prognosis.

摘要

该综合征的特征是肺毛细血管床发生改变,使得富含蛋白质的水肿液得以滤过。它引发肺泡-毛细血管阻滞并导致顺应性下降。根据涉及肺毛细血管改变(如爆炸、休克、微栓塞)的临床情况可作出肯定诊断。氧分压(pO2)早期即显著下降。顺应性下降出现较晚,导致通气不足,需要通气支持。双肺野弥漫性放射学不透光区具有特征性,包括其表现及病程迁延。在鉴别诊断中,应设法排除急性肺水肿和支气管源性难治性低氧血症。病情的预后取决于病程(pO2、可能出现的通气不足、放射学影像)及治疗情况。尽管该综合征持续超过一两周预后不佳,但已知有些病例病程超过三周且痊愈后无后遗症。该综合征可并发心功能不全、器质性肾衰竭,这又会使预后恶化。

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