Fluid lungs

Description:

Fluid lungs – one of the heaviest, quite often deadly complications of a number of diseases connected with excess transuding of an intercellular lymph on the surface of the diffusion alveolar capillary membrane of lungs.
Kinds of a fluid lungs:
Distinguish a hydrostatic and membranogenny fluid lungs which origin variously.

Fluid lungs symptoms:

Arises at any time, but is more often in night or hours at dawn. Exercise stresses, overcooling, psychoemotional tension, dreadful dreams, transition of the patient from vertical in horizontal position provoke an attack, at the same time the pulmonary volume of blood increases on average by 300 ml. Suffocation arises or amplifies suddenly. Paroxysmal cough can be an equivalent of an asthma. The patient is forced to reach a sitting position, having lowered legs from a bed (the provision of an orthopnea). Auxiliary respiratory muscles participate in the act of breath. There are cyanosis of lips and nails, a perspiration, an exophthalmos. Patients are excited, uneasy. Extremities are cold. There can be bronchospasm phenomena because of hypostasis of a mucous membrane of bronchial tubes. Cough dry, superficial or hoarse, an asthma to 40 — 60 in min. Tachycardia is characteristic. The ABP is, as a rule, raised. At percussion of lungs the bandbox sound at the expense of acute emphysema of lungs is noted. Breath is loud, strengthened. At the phenomena of a bronchospasm the dry whistling scattered rattles are listened. Wet rattles at this stage of a disease are not defined. Cardiac sounds are listened hardly because of noisy breath and rattles; the increased painful liver, hypostases of the lower extremities can be defined.

The alveolar fluid lungs is characterized by sharp respiratory insufficiency: the expressed short wind, the accruing diffusion cyanosis. Consciousness of patients is confused. In process of increase in hypostasis block goes deep, up to a coma. The person одутловато, the neck veins which bulked up. Integuments are wet, at a stroke hot at the expense of a hyperthermia of the central genesis. Rattles in lungs are heard at distance as bubbling. On lips sick foam bubbles. Its pink color is caused by the uniform elements of blood getting into alveoluses that is characteristic of flu, a lung fever. The thorax is expanded; at percussion a percussion sound mosaic: sites of a tympanites alternate with the obtusion centers. At auscultation of lungs along with dry rattles a lot of sonorous mixed wet rattles is listened (from small - to large-bubbling). The Auskultativny picture is dynamic; best of all rattles are heard in upper and average parts of lungs. The ABP is more often raised if hypostasis arises not against the background of shock, but in an end-stage of the ABP progressively decreases, pulse becomes threadlike, breath superficial, then as Cheyn — Stokes. Unconscious patient. Death is caused by asphyxia.

Fluid lungs reasons:

The hydrostatic fluid lungs arises at diseases at which the vnutrikapilyarny hydrostatic pressure of blood increases to 7-10 mm of mercury., what conducts to an exit of a liquid part of blood in an interstitium in quantity, exceeding a possibility of its removal in lymphatic ways.

The Membranogenny fluid lungs develops in cases of primary increase in permeability of capillaries of lungs which can arise at various syndromes.

The essence of edematization of lungs consists in the strengthened inflow of liquid to pulmonary fabric which is not counterbalanced with its return absorption in a vascular bed. At the same time proteinaceous transudate of blood and pulmonary surfactant on such background is easily passed into a gleam of alveoluses, mix up with air there and form resistant foam which fills pneumatic ways, interfering with access of oxygen to a gas exchange zone of lungs and to the alveolar capillary membrane.

Most often swelled meets in therapeutic practice. Emergence of a fluid lungs is promoted first of all:

    * diseases of cardiovascular system: atherosclerotic cardiosclerosis, postinfarction cardiosclerosis, idiopathic hypertensia of any etiology, acute myocardial infarction;
    * damages of heart and aorta: insufficiency of the aortal valve, aortic aneurysm; rheumatic character: acute rheumatic cardiomitral, aortal heart diseases, are more rare a subacute and septic endocarditis;
    * and at children's and teenage age – congenital anomalies of heart and vessels: aorta coarctation, not fusion of a botallov of a channel, defect of an interatrial or interventricular partition, anastomosis of pulmonary veins with the left auricle, aortal кульмональные shunts.

Treatment of the Fluid lungs:

Cardiological patients with the main tactical direction have to have a decrease in hydrostatic pressure in vessels of a small circle. It is reached by simplification of work of a left ventricle by decrease in the system ABP. For this purpose use ganglioblokator: enter slowly intravenously struyno under control of the ABP 0,5 — 1 ml of 5% of solution of Pentaminum into 20 ml of isotonic solution of sodium chloride. In order to avoid heavy hypotonia it is optional to enter all volume of medicine — after decrease in the ABP level more than on from the initial systolic ABP infusion can be stopped.

The managed hypotonia is reached by intravenous drop administration of an arfonad — 250 mg in 100 — 150 ml of normal saline solution or 5% of solution of glucose. Rate of administering is regulated depending on the ABP; if it decreases, intake of solution in a vein is stopped and the ABP raises a little.

In recent years apply "peripheral vazodilatator" — the means similar to ganglioblokator: nitroglycerine, Sodium nitroprussidum. Their action is based on decrease in a venous tone and venous return to heart, a spasmolysis of pulmonary vessels and decrease in the general pulmonary resistance. At the expense of it hypertensia of a small circle is eliminated. Besides, Sodium nitroprussidum has bronkhodilatiruyushchy effect: its use is a choice method at mitral insufficiency: resistance to outflow of blood from a left ventricle in an aorta decreases that levels the return blood flow in the left auricle and by that reduces pressure in a small circle. Therapy can be begun with reception of the tableted nitroglycerine form: 1 — 2 tablets under language then to pass to intravenous drop administration 1 ml of 0,01% of Solution Nitroglycerini or 50 mg of Sodium nitroprussidum into 500 ml of 5% of solution of glucose with a speed of 6 — 7 thaws a minute under control of the ABP. It must be kept in mind a possibility of use of ganglioblokator and peripheral vazodilatator not only at high, but also at moderately raised and normal ABP.