[1]李杰,姜正辕,冉军民,等.自发性蛛网膜下腔出血合并神经源性肺水肿的诊治[J].中国临床神经外科杂志,2024,29(10):595-598.[doi:10.13798/j.issn.1009-153X.2024.10.005]
　LI Jie,JIANG Zheng-yuan,RAN jun-min,et al.Diagnosis and treatment of spontaneous subarachnoid hemorrhage complicated with neurogenic pulmonary edema[J].,2024,29(10):595-598.[doi:10.13798/j.issn.1009-153X.2024.10.005]
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自发性蛛网膜下腔出血合并神经源性肺水肿的诊治()

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年10期
页码:
595-598
栏目:
论著
出版日期:
2024-10-30

文章信息/Info

Title:
Diagnosis and treatment of spontaneous subarachnoid hemorrhage complicated with neurogenic pulmonary edema
文章编号:
1009-153X（2024）10-0595-04
作者:
李杰; 姜正辕; 冉军民; 康宏达
746000甘肃，陇南市第一人民医院神经外科（李杰、姜正辕、冉军民、康宏达）
Author(s):
LI Jie;  JIANG Zheng-yuan;  RAN jun-min;  KANG hong-da
Department of Neurosurgery, Longnan First People's Hospital, Longnan 746000, China
关键词:
动脉瘤性蛛网膜下腔出血; 神经源性肺水肿; 治疗
Keywords:
Spontaneous subarachnoid hemorrhage;  Neurogenic pulmonary edema;  Treatment
分类号:
R 743.9
DOI:
10.13798/j.issn.1009-153X.2024.10.005
文献标志码:
A
摘要:
目的 总结自发性蛛网膜下腔出血合并神经源性肺水肿的救治经验。方法 回顾性分析2018年1月至2022年12月收治的17例自发性蛛网膜下腔出血合并神经源性肺水肿的临床资料。结果 17例入院时均通过卒中中心绿色通道、多学科联合诊疗（MDT）、ICU治疗等得到及时规范的救治。入院时均存在呼吸困难，3例呼吸衰竭抢救后趋于平稳，14例呼吸良好。17例均急诊DSA检查，14例（82.4%）为动脉瘤破裂，发现动脉瘤17枚；3例（17.6%）原因不明。动脉瘤破裂者均行介入栓塞治疗，12例单纯栓塞，5例支架辅助栓塞，术后均ICU救治1~2周；3例未发现动脉瘤者普通病房救治。住院期间，无死亡。出院后随访半年，GCS评分13分1例，15分16例；日常生活能力量表分级0级9例，1级6例，2级2例。结论 自发性蛛网膜下腔出血合并神经源性肺水肿需综合救治，应发挥卒中中心绿色通道、MDT及ICU系统救治的作用，同时临床以病因治疗为主，并重视呼吸系统治疗、循环液体量限制及营养支持。
Abstract:
Objective To summarize the treatment experience of spontaneous subarachnoid hemorrhage complicated with neurogenic pulmonary edema. Methods A retrospective analysis was conducted on the clinical data of 17 patients with spontaneous subarachnoid hemorrhage complicated with neurogenic pulmonary edema admitted from January 2018 to December 2022. Results All 17 patients received timely and standardized treatment through the stroke center's green channel, multidisciplinary team (MDT) diagnosis and treatment, and ICU care upon admission. All patients presented with varying degrees of dyspnea at admission, with 3 cases of respiratory failure stabilizing after rescue, and 14 cases having good respiratory function. All 17 cases underwent emergency DSA examination, and 14 cases (82.4%) were diagnosed with ruptured aneurysms, with a total of 17 aneurysms identified; 3 cases (17.6%) had unknown causes. The patients with ruptured aneurysms underwent interventional embolization treatment, including 12 cases of simple embolization and 5 cases of stent-assisted embolization. The patients with ruptured aneurysms were treated in the ICU for 1~2 weeks after the operation; the 3 cases without identified aneurysms were treated in the general ward. During hospitalization, there were no deaths. At the 6-month follow-up after discharge, the GCS score was 13 in 1 case and 15 in 16 cases; the classification of the Activities of Daily Living Scale was grade 0 in 9 cases, grade 1 in 6 cases, and grade 2 in 2 cases. Conclusions Comprehensive treatment is necessary for spontaneous subarachnoid hemorrhage complicated with neurogenic pulmonary edema. The role of the stroke center's green channel, MDT, and ICU should be fully utilized. At the same time, etiological treatment should be the main focus in clinical practice, with attention also given to respiratory system treatment, fluid volume restriction, and nutritional support.

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备注/Memo

备注/Memo:
（2023-07-21收稿，2024-06-10修回）
更新日期/Last Update: 2024-10-30