嚴重二尖瓣逆流引發急性肺水腫導致呼吸衰竭之呼吸照護經驗

Respiratory Care Experience of Severe Mitral Regurgitation Induced Acute Pulmonary Edema Leading to Respiratory Failure

10.6269/JRT.201907_18(1).0006

劉春雨(Chun-Yu Liu)；張蕙明(Hui-Ming Chang)；林鈺姿(Yu Zih Lin)

二尖瓣逆流 ； 心因性肺水腫 ； mitral regurgitation (MR) ； Cardiogenic pulmonary edema

呼吸治療

18卷1期（2019 / 07 / 01）

61 - 69

繁體中文

心因性肺水腫病人會因氣體交換障礙發生呼吸困難、血氧下降等情形，若未及時處置，病人會出現急性呼吸衰竭，是一種嚴重且危及生命的急症。當心臟功能變差，左心負荷增加以及心搏出量減少，造成肺靜脈及肺微血管內的液體淨水壓增加，肺微血管內的液體滲出至血管外的速度，超過肺部再吸收排除的能力，致使液體滲透到組織間隙及肺泡，即出現心因性肺水腫。本篇將會針對二尖瓣逆流合併心因性肺水腫病人在使用正壓機械通氣合併高吐氣末陽壓治療期間，對於肺水腫的改善去做更深入的探討。

Cardiogenic pulmonary edema due to gas exchange disorders can cause dyspnea and desatruation. If the patient without treatment, the patient may experience acute respiratory failure and it is a serious and dangerous event. When the heart is impaired, it will increase the afterload and decrease the cardiac output. It will also increase the hydrostatic pressure of pulmonary vein and microvascular circulation. Due to the extravascular volume more than reabsorption in pulmonary microvascular circulation, the fluid shift to the interstitial tissue and alveolar space; this will lead to cardiogenic pulmonary edema. Regarding to patients with mitral regurgitation and cardiogenic pulmonary edema, we will further discuss and research for the benefits for pulmonary edema of using Positive pressure ventilation and high level PEEP.