ards进展（急性呼吸窘迫综合征）-施焕中.ppt

急性呼吸窘迫综合征广西医科大学第一附属医院呼吸内科施焕中广西医科大学第一附属医院危重症中心NEnglJMed2003;348:683-,6,,patientswereinterviewedandunderwentaphysicalexamination,pulmonary-functiontesting,asix-minute–walktest,andaquality-of-(medianage,45years)andseverelyill(medianAcutePhysiology,Age,andChronicHealthEvaluationscore,23)andhadalongstayintheintensivecareunit(median,25days).Patientshadlost18percentoftheirbase-,butcarbonmonoxidediffusioncapacityremainedlowthroughoutthe12-monthfollow-,-itemShort-FormGeneralHealthSurvey(ahealth-relatedquality-of-lifemeasure)increasedfrom0at3monthsto25at12months(scoreinthenormalpopulation,84).Thedistancewalkedinsixminutesincreasedfromamedianof281mat3monthsto422mat12months;,theabsenceofillnessacquiredduringtheintensivecareunitstay,andysfunctionwereassociatedwithbetterfunctionalstatusduringtheone-yearfollow-,;348:683-、进行性缺氧性呼吸衰竭。ALI/ARDS具有性质相同的病理生理改变,严重的ALI即被定义为ARDS。ALI/ARDS以肺微血管通透性增加、肺气容积减少、肺顺应性降低和严重肺内分流及通气/血流比例失调为病理生理特点,临床表现为不易缓解的急性进行性缺氧性呼吸衰竭,胸部X线可见肺部浸润征象。高危因素一、直接肺损伤因素严重肺部感染、胃内容物吸入、溺水、吸入有毒气体、肺挫伤、氧中毒等。二、间接肺损伤因素脓毒症、休克、严重非胸部创伤、重症胰腺炎、大量输血、输液、体外循环、DIC等。发病机制一、血管内皮和气道上皮损伤二、中性粒细胞介导的肺损伤三、其他炎症机制细胞因子表面活性物质呼吸机引起的肺损