Quantitative Assessment of Pulmonary Edema
Quantitative Assessment of Pulmonary Edema
复制标题
肺水肿的定量评估
作者：
Robert Levine;R. Mellins;A. Fishman
本研究试图建立一种可靠的方法来定量区分肺充血和充血水肿。在完整的麻醉犬中，通过在左心房中充盈球囊，然后进行盐水血液稀释来产生肺充血。监测的血流动力学事件包括左心房和肺动脉压以及胶体渗透压。临床标准，如呼吸的频率和频率，胸部X线片，以及是否有可闻的罗音，不能可靠地区分充血和水肿。充血和水肿比单纯充血更严重地改变了呼吸机制，但存在相当大的重叠。如Chinard和恩斯所述，通过T-1824和氚水同时稀释曲线测定肺血容量和肺血管外水空间是检测和定量肺水肿的可靠方法。在正常麻醉犬中，通过该技术测量的水空间平均为3.5 ml/kg体重。它与尸检时测定的总肺含水量相关性良好，即使在存在严重肺水肿的情况下，也能测量总肺含水量的恒定分数（约50%）。根据本研究的结果，当血管外水空间为6.0 ml/kg体重或更大时，尸检时可以可靠地预测肺水肿。
The present study has attempted to establish a reliable method for distinguishing quantitatively between pulmonary engorgement and engorgement plus edema. Pulmonary engorgement was produced in intact, anesthetized dogs by inflating a balloon in the left atrium followed by saline hemodilution. Hemodynamic events monitored included left atrial and pulmonary arterial pressures, and the colloid osmotic pressure. Clinical criteria, such as the rate and frequency of breathing, the chest roentgenogram, and the presence of audible rales, failed to distinguish reliably between engorgement and edema. The mechanics of breathing were more severely altered by engorgement and edema than by engorgement alone, but considerable overlap was present. Determination of the pulmonary blood volume and the extravascular water space of the lungs, by means of simultaneous T-1824 and tritiated water dilution curves, as described by Chinard and Enns, was a reliable method of detecting and quantifying pulmonary edema. The water space measured by this technique averaged 3.5 ml/kg body wt in normal, anesthetized dogs. It correlated well with the total lung water content determined at autopsy, measuring a constant fraction (approximately 50%) of the total lung water content, even in the presence of severe pulmonary edema. According to the results of the present study, pulmonary edema could be predicted reliably at autopsy when the extra-vascular water space was 6.0 ml/kg of body wt or greater.