每日一题_2022.4.3

A 58-year-old woman with a past medical history of hypertension is admitted to the ICU for evaluation of the worst headache of her life and a syncopal event at home. Initial head CT reveals diffuse subarachnoid hemorrhage. Her Glasgow Coma Scale score is 7, blood pressure 178/100 mm Hg, heart rate 108 beats/min, respiratory rate 42 beats/min, pulse oximetry 88% on 4-liter nasal cannula. She is intubated with FiO2 1.0. Chest radiograph is shown below. Arterial blood gas analysis reveals: pH 7.20, pCO2 30 mm Hg, pO2 88 mm Hg, and hemoglobin oxygen saturation 97%. Initial echocardiography shows a hyperdynamic state with no regional wall motion abnormalities. Right ventricular function appears to be within normal limits. The inferior vena cava collapsibility index is 50%.

Which of the following is the most likely explanation for her hypoxic respiratory failure?

A. Neurogenic pulmonary edema

B. Congestive heart failure secondary to diastolic dysfunction 

C. Pulmonary embolism with acute cor pulmonale

D. Pneumothorax

E. Aspiration pneumonia

答案解析：

神经源性肺水肿(NPE)是一种认识不足和诊断不足的肺部损害形式，使急性神经系统疾病复杂化，不能通过心血管或肺部病理学来解释。根据2012年柏林对急性呼吸窘迫综合征(ARDS)的定义，NPE应被视为ARDS的一种形式，并警告其具有不同的病理生理学。超声心动图显示在轻度血容量不足的情况下存在高动力状态，因此不太可能发生急性舒张期充血性心力衰竭。尽管昏迷患者可能发生吸入性肺炎或肺炎，但x线模式和发病不太可能用感染过程来解释。胸片未发现气胸。超声心动图显示右心室功能正常可消除伴有血流动力学或呼吸功能受损的显著肺栓塞。

正确答案：A