Incidence and pathophysiology of pulmonary edema in fulminant hepatic failure.
Incidence and pathophysiology of pulmonary edema in fulminant hepatic failure.
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DOI：
10.1016/0016-5085(78)90142-7
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发表时间：
1978-05
期刊：
影响因子：
29.4
通讯作者：
P. Trewby;R. Warren;S. Contini;W. Crosbie;S. Wilkinson;J. Laws;Roger Williams
中科院分区：
文献类型：
--
作者：
P. Trewby;R. Warren;S. Contini;W. Crosbie;S. Wilkinson;J. Laws;Roger Williams
100例暴发性肝衰竭患者中有37例有肺水肿的临床和放射学证据。所有患者均无左心衰竭的临床表现，12例患者的肺动脉楔压正常。同样，没有证据表明肾衰竭、内毒素血症或低白蛋白血症。然而，在脑水肿患者中，肺水肿的发生率显著更高，这表明肺水肿的中心起源或两个部位诱发水肿的共同因素。另一个局部因素可能是肺内血管舒张。11例患者的详细同位素研究显示，肺水肿患者的肺血管外水体积显著增加，这与放射学变化的严重程度一致。尽管有肺水肿的患者总死亡率高于无肺水肿的患者，但差异无显著性，除3例患者外，所有患者均在早期正压通气和呼气压通气下获得了充分的氧合。
Thirty-seven of 100 consecutive patients with fulminant hepatic failure had clinical and radiological evidence of pulmonary edema. None of them had clinical evidence of left heart failure, and the pulmonary artery wedge pressure measured in 12 patients was normal. Similarly, there was no evidence to incriminate renal failure, endotoxemia, or hypoalbuminemia. However, there was a significantly higher incidence of pulmonary edema in patients with cerebral edema, suggesting either a central origin for the pulmonary edema or common factors predisposing to edema in both sites. An additional local factor may have been the presence of intrapulmonary vasodilatation. Detailed isotope studies in 11 patients showed a significantly increased pulmonary extravascular water volume in the patients with pulmonary edema which was in keeping with the severity of the radiological changes. Although the over-all mortality was higher in those patients with pulmonary edema than in those without, the difference was not significant, and early ventilation with positive and expiratory pressure achieved adequate oxygenation in all but 3 patients.