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目的分析急性脑血管病并发神经源性肺水肿临床特点以及CT、X线影像学表现。方法选择2012年10月-2015年1月诊断急性脑血管病并发神经源性肺水肿患者80例,统计其临床发病部位。入院后即给予免疫化学发光法检测血浆脑钠肽(BNP)水平、床边心动超声检查左室射血分数(LVEF)值以及采用格拉斯哥评分(GCS)判断患者昏迷指数。入组患者均在入院24h内给予行肺部CT平扫检查以及床旁X线影像学检查,依据患者影像学表现分为中心性肺水肿与间质性肺水肿。分析患者血浆BNP水平与LVEF值、GCS评分之间相关性,比较中心性肺水肿与间质性肺水肿组间BNP水平差异。对患者肺部影像学表现及鉴别诊断进行分析。结果入组急性脑血管病并发神经源性肺水肿患者80例,其中,脑出血55例(脑干出血9例、基底节区出血18例、小脑出血8例、蛛网膜下腔出血20例),缺血性脑血管病25例(脑干梗死6例,小脑梗死4例,前循环缺血梗死15例)。出血性脑血管病发病率(68.75%)高于缺血性脑血管病(31.25%),差异有统计学意义(P<0.05)。患者肺CT检查76例,首次诊断行床旁胸片检查4例,肺部影像学表现为中心性肺水肿14例,间质性肺水肿66例。心脏超声检查LVEF>47%72例,左室射血分数减低(EF<47%)8例。GCS评分<7分68例,GCS评分7~10分12例。BNP与GCS之间呈直线相关(r=0.683,P<0.05),与LVEF比值相关性差(r=0.165)。中心性肺水肿组BNP水平为(3487.91±369.45)pg/ml,间质性肺水肿组BNP水平为(3768.36±390.52)pg/ml,2组BNP水平差异无统计学意义(P>0.05)。结论急性脑血管病并发神经源性肺水肿患者临床发病以出血性脑血管病多见,其影像学表现以中心性肺水肿与间质性肺水肿表现为主,影像学表现特点与血浆BNP水平无明显相关性。血浆BNP水平与患者昏迷指数评分存在一定相关性,而与LVEF无明显相关。
Objective To analyze the clinical features of acute cerebrovascular disease complicated with neurogenic pulmonary edema and CT and X-ray findings. Methods Eighty patients with acute cerebrovascular disease complicated with neurogenic pulmonary edema were selected from October 2012 to January 2015, and the clinical incidence of the disease was calculated. Immunochemical chemiluminescence was used to detect plasma BNP level after bedside admission, left ventricular ejection fraction (LVEF) by bedside echocardiography, and GCS to determine coma index. The patients were admitted to the hospital within 24 hours of line CT scan and bedside X-ray imaging examination, according to the patient’s imaging findings were divided into central pulmonary edema and interstitial pulmonary edema. Analysis of plasma BNP levels in patients with LVEF value, GCS score between the correlation between central pulmonary edema and interstitial pulmonary edema BNP levels were compared. Analysis of the patient’s lung imaging findings and differential diagnosis. Results A total of 80 patients with acute cerebral vascular disease complicated with neurogenic pulmonary edema were enrolled. Among them, 55 were intracerebral hemorrhage (9 cases of hemorrhage in brainstem, 18 cases of basal ganglia hemorrhage, 8 cases of cerebellar hemorrhage and 20 cases of subarachnoid hemorrhage) 25 cases of ischemic cerebrovascular disease (6 cases of brainstem infarction, 4 cases of cerebellar infarction and 15 cases of anterior circulation ischemic infarction). The incidence of hemorrhagic cerebrovascular disease (68.75%) was higher than that of ischemic cerebrovascular disease (31.25%), the difference was statistically significant (P <0.05). Sixty-six cases were diagnosed as pulmonary CT, four cases were diagnosed as bed-side chest radiography for the first time, 14 cases of central pulmonary edema and 66 cases of interstitial pulmonary edema. Echocardiography LVEF> 47% 72 cases, reduced left ventricular ejection fraction (EF <47%) in 8 cases. GCS score <7 points 68 cases, GCS score 7 to 10 points in 12 cases. There was a linear correlation between BNP and GCS (r = 0.683, P <0.05), but not correlated with LVEF (r = 0.165). The level of BNP was (3487.91 ± 369.45) pg / ml in central pulmonary edema group, and (3768.36 ± 390.52) pg / ml in interstitial pulmonary edema group. There was no significant difference between the two groups (P> 0.05). Conclusions The clinical manifestations of acute cerebrovascular disease complicated with neurogenic pulmonary edema are mostly hemorrhagic cerebrovascular disease. The imaging manifestations are mainly central pulmonary edema and interstitial pulmonary edema. The features of imaging and the plasma BNP level No significant correlation. Plasma BNP levels and coma index score there is a certain correlation, but no significant correlation with LVEF.