{"title":"Pulmonary oedema","authors":"Samuel Oram","doi":"10.1016/S0366-0869(58)80079-9","DOIUrl":null,"url":null,"abstract":"<div><p>Acute pulmonary œdema is encountered in a great variety of patients, the commonest of which have cardiac disease, usually left ventricular failure or mitral stenosis. The severity may vary from fulminating to chronic. Two types of patient may be recognised, namely those with a high blood pressure and full pulse, and those with a low blood pressure, poor pulse and a tendency to shock.</p><p>The exact mechanism of the production of pulmonary œdema is still uncertain, but a high pulmonary capillary pressure, increased permeability of the pulmonary capillaries and a decrease in the osmotic pressure are the most important features. The level of the pulmonary capillary pressure in both left ventricular failure and mitral stenosis always exceeds the effective osmotic pressure of the plasma.</p><p>Emergency treatment is to prop the patient as upright as possible and if necessary insert a suction catheter down the trachea. Other useful agents in treatment are morphine, aminophylline, venesection, oxygen and mercurial diuretics. Digitalis should be used with caution. De-foaming agents are simple to use and seem worthy of further trial. Before using any particular method of treatment it should be determined whether a reduction in venous return is likely to prove beneficial, for example in patients with a raised blood pressure, or harmful, as in those with a low blood pressure and tendency to shock.</p></div>","PeriodicalId":100202,"journal":{"name":"British Journal of Tuberculosis and Diseases of the Chest","volume":"52 2","pages":"Pages 114-120, IN3-IN4, 121-125"},"PeriodicalIF":0.0000,"publicationDate":"1958-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0366-0869(58)80079-9","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Tuberculosis and Diseases of the Chest","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0366086958800799","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1

Abstract

Acute pulmonary œdema is encountered in a great variety of patients, the commonest of which have cardiac disease, usually left ventricular failure or mitral stenosis. The severity may vary from fulminating to chronic. Two types of patient may be recognised, namely those with a high blood pressure and full pulse, and those with a low blood pressure, poor pulse and a tendency to shock.

The exact mechanism of the production of pulmonary œdema is still uncertain, but a high pulmonary capillary pressure, increased permeability of the pulmonary capillaries and a decrease in the osmotic pressure are the most important features. The level of the pulmonary capillary pressure in both left ventricular failure and mitral stenosis always exceeds the effective osmotic pressure of the plasma.

Emergency treatment is to prop the patient as upright as possible and if necessary insert a suction catheter down the trachea. Other useful agents in treatment are morphine, aminophylline, venesection, oxygen and mercurial diuretics. Digitalis should be used with caution. De-foaming agents are simple to use and seem worthy of further trial. Before using any particular method of treatment it should be determined whether a reduction in venous return is likely to prove beneficial, for example in patients with a raised blood pressure, or harmful, as in those with a low blood pressure and tendency to shock.

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肺水肿。
急性肺源性œdema在多种患者中都有遇到,其中最常见的有心脏疾病,通常是左心室衰竭或二尖瓣狭窄。其严重程度可从暴发性到慢性不等。可以识别出两种类型的患者,即血压高、脉搏饱满的患者,以及血压低、脉搏差、有休克倾向的患者。肺œdema产生的确切机制尚不清楚,但肺毛细血管压力高、肺毛细血管通透性增加和渗透压降低是其最重要的特征。左心室衰竭和二尖瓣狭窄的肺动脉毛细血管压力水平总是超过血浆的有效渗透压。紧急治疗是使病人尽可能直立,必要时在气管内插入吸管。其他有用的治疗药物有吗啡、氨茶碱、静脉切断术、氧气和汞利尿剂。应谨慎使用洋地黄。消泡剂使用简单,似乎值得进一步试验。在使用任何特定的治疗方法之前,应确定减少静脉回流是否可能被证明是有益的,例如对于血压升高的患者,还是有害的,例如对于低血压和倾向于休克的患者。
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