Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury
Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury
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DOI：
10.3171/jns.2001.95.4.0560
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发表时间：
2001-10-01
影响因子：
4.1
通讯作者：
Robertson, CS
中科院分区：
文献类型：
--
作者：
Contant, CF;Valadka, AB;Robertson, CS
Object.探讨重型颅脑损伤后成人呼吸窘迫综合征（ARDS）发生的相关因素。ARDS的存在使严重脑损伤患者的治疗复杂化，这既是因为缺氧会对大脑造成额外的损伤，也是因为用于保护肺和改善ARDS患者氧合的治疗会减少脑血流量（CBF）并增加颅内压（ICP）。在最近的一项关于两种头部损伤管理策略（ICP靶向和CBF靶向）的随机试验中，观察到CBF靶向组的ARDS发病率增加了5倍。将18例发生ARDS患者的损伤严重程度、生理数据和治疗数据与随机试验中未发生ARDS的其余171例患者进行比较。Logistic回归分析用于研究与ARDS发生相关的因素之间的相互作用，在最终的精确Logistic回归模型中，发现几个因素与ARDS风险增加显著相关：应用肾上腺素（风险增加5.7倍），给予大于中位剂量的多巴胺（风险增加10.8倍）和药物滥用史（风险增加3.1倍）。虽然这项临床试验的目的不是研究管理策略与ARDS发生的关系，但数据强烈表明，在这一高危患者组中，诱导性高血压与症状性ARDS的发生有关。
Object. The factors involved in the development of adult respiratory distress syndrome (ARDS) after severe head injury were studied. The presence of ARDS complicates the treatment of patients with severe head injury, both because hypoxia causes additional injury to the brain and because therapies that are used to protect the lungs and improve oxygenation in patients with ARDS can reduce cerebral blood flow (CBF) and increase intracranial pressure (ICP). In a recent randomized trial of two head-injury management strategies (ICP-targeted and CBF-targeted), a fivefold increase in the incidence of ARDS was observed in the CBF-targeted group.Methods. Injury severity, physiological data, and treatment data in 18 patients in whom ARDS had developed were compared with the remaining 171 patients in the randomized trial in whom it had not developed. Logistic regression analysis was used to study the interaction of the factors that were related to the development of ARDS.In the final exact logistic regression model, several factors were found to be significantly associated with an increased risk of ARDS: administration of epinephrine (5.7-fold increased risk), administration of dopamine in a larger than median dose (10.8-fold increased risk), and a history of drug abuse (3.1-fold increased risk).Conclusions. Although this clinical trial was not designed to study the association of management strategy and the occurrence of ARDS, the data strongly indicated that induced hypertension in this high-risk group of patients is associated with the development of symptomatic ARDS.