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目的探讨动脉瘤性蛛网膜下腔出血(subarachnoid hemorrhage,SAH)合并急性神经源性肺水肿(acute neurogenic pulmonary edema,ANPE)的发病因素及诊疗要点。方法病例组为12例动脉瘤性SAH合并ANPE患者,对照组为同期收治的12例动脉瘤性SAH未合并ANPE患者,回顾病例组的治疗过程,并对比两组的性别、年龄、动脉瘤部位、发病到接受手术的时间、手术持续时间、手术方式、术中液体量、术中液体量/手术时间等资料。结果两组病例的性别、年龄、动脉瘤位置、手术持续时间、术中手术方式无统计学差异(P>0.05),病例组发病到接受手术的时间短,术中液体量及液体量/手术持续时间明显大于未合并ANPE患者(P<0.05)。病例组呼吸机辅助呼吸6～14 d,留置气管插管时间9～20 d,均未行气管切开术,痊愈出院,未遗留呼吸、神经功能障碍。结论对于急诊行动脉瘤栓塞的患者,尤其要注重术中液体量及术中补液速度的管理,治疗方面需同时兼顾中枢原发因素和肺水肿。
Objective To investigate the etiological factors and diagnosis and treatment of subacute subarachnoid hemorrhage (SAH) with acute neurogenic pulmonary edema (ANPE). Methods A total of 12 patients with aneurysmal SAH and ANPE were enrolled in this study. Twelve patients with aneurysmal SAH and ANPE were enrolled in the control group. The course of treatment was retrospectively analyzed. The gender, age, , The onset of surgery to accept the time, duration of surgery, surgical methods, intraoperative fluid volume, intraoperative fluid volume / operation time and other information. Results There were no significant differences in gender, age, location of aneurysm, duration of operation and surgical procedure between the two groups (P> 0.05). The time between the onset of the operation and the time of operation was short in the case group. The amount of fluid and fluid volume The duration was significantly greater than those without ANPE (P <0.05). Case group ventilator-assisted breathing 6 ~ 14 d, indwelling endotracheal intubation time 9 ~ 20 d, did not undergo tracheotomy, discharged, no left breathing, neurological dysfunction. Conclusions Patients with emergency aneurysm embolism should pay special attention to the management of intraoperative fluid volume and intraoperative fluid infusion rate. Both the primary central factor and pulmonary edema should be taken into consideration in the treatment.