中文摘要：

目的提高急诊临床对非创伤性脑出血患者发生神经源性肺水肿（NPE）的早期诊治水平。方法将2008年10月至2014年10月中国人民解放军总医院第一附属医院急救部收治的非创伤性急性脑出血患者中符合入选标准的140例患者分为发病后发生NPE组（n=25）及未发生NPE（n=115）,对两组患者诊治过程中的临床资料进行分析和比较。结果虽然NPE组与非NPE组患者平均动脉压相似,但两组患者动脉血气中的p H值（p H 7.32比7.39,P=0.002）及HCO3-浓度（20.6 mmol/L比22.7 mmol/L,P=0.01）差异均有统计学意义。NPE组与非NPE组患者的年龄（50.1岁比65.1岁,P=0.0008）和血糖水平（15.4 mmol/L比10.78 mmol/L,P=0.001）差异也有统计学意义。急诊救治24 h时,NPE组25例患者中20例有效;5例死亡,其中3例暴发性NPE（均在1 h内发病）死于急性呼吸窘迫综合征并发全身多系统器官功能衰竭,2例死于脑疝。结论 NPE是脑出血患者中少见且预后差的严重并发症之一。对相对年轻、高血糖及血气偏酸的脑出血患者要警惕早期NPE的发生,积极预防和及时治疗可以提高该病救治成功率。

英文摘要：

Objective To improve the management of the early neurogenic pulmonary edema（ NPE）in patients with non-traumatic cerebral hemorrhage. Methods Totally 140 eligible patients with non-traumatic cerebral hemorrhage who were treated in the emergency department of our hospital from October 2008 to October2014 were divided into two groups： NPE group（ n = 25） and non-NPE group（ n = 115）. The clinical data were analyzed and compared. Results Although the mean arterial pressure was similar between these two groups,the median p H and the bicarbonate ion（ HCO3-） were significantly lower in the NPE group than in the non-NPE group（ p H： 7. 32 vs. 7. 39, P = 0. 002; HCO3-,20. 6 mmol /L vs. 22. 7 mmol /L,P = 0. 01）.Multivariate regression analysis indicated that younger age and higher glucose level were significantly correlated with the early onset of NPE in the NPE group than in the non-NPE group（ age： 50. 1 years vs. 65. 1 years,P =0. 0008; glucose,15. 4 mmol / L vs. 10. 78 mmol / L,P = 0. 001）. There were only 3 patients in all with non-traumatic cerebral hemorrhage happened the fulminant NPE in 1 hour. Within 24 hours after patients visited the emergency room,the condition was improved in 20 of 25 patients in the NPE group. However,5 patients died,among whom 3 patients with fulminant NPE（ onset within 1 hour） died due to acute respiratory distress syndrome and complicated with multiple organ failure,and 2 died of cerebral hernia. Conclusions NPE is a rare and severe complication in patients with non traumatic cerebral hemorrhage. The possibility of NPE should be considered in relatively young patients with higher glucose and lower blood p H value. Timely prevention and treatment can improve the outcomes.