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肺性脑病并发脑疝并非罕见,约占重型肺性脑病的10.9%,但至今尚未引起临床医师的足够重视,致使处理不及时,病死率可高达92.6%。一、发病机理肺性脑病并发脑疝的主要发病机理为脑水肿、颅内高压,可由下列原因引起:①高碳酸血症:肺心病呼吸衰竭时二氧化碳潴留,PaCO_2升高,特别是超过9.31KPa(70mmHg)时,脑组织内pH值降低,致使细胞内酸中毒,血管扩张,毛细血管通透性增加,引起以细胞间质为主的脑水肿;②低氧血症:缺氧时,特别是PaO_2<6.65KPa(50mmHg)时,物质进行无氧代谢,能量供应不足,
Pulmonary encephalopathy complicated with herniation is not uncommon, accounting for 10.9% of severe pulmonary encephalopathy, but so far has not attracted enough attention of clinicians, resulting in the treatment is not timely, the case fatality rate can be as high as 92.6%. First, the pathogenesis of pulmonary encephalopathy complicated with cerebral hernia main pathogenesis of cerebral edema, intracranial hypertension, can be caused by the following reasons: ① hypercapnia: pulmonary heart disease respiratory failure, carbon dioxide retention, PaCO_2 increased, especially over 9.31KPa (70mmHg), the brain tissue pH value decreased, resulting in intracellular acidosis, vasodilation, increased capillary permeability, causing the stromal-based brain edema; ② hypoxemia: hypoxia, especially Is PaO_2 <6.65KPa (50mmHg), the material for anaerobic metabolism, lack of energy supply,