急性肺损伤（ALI）.ppt

第二十二章急性肺损伤（ALI） 急性呼吸窘迫综合征（ARDS） ACUTE LUNG INJURY ACUTE RESPIRATORY DISTRESS SYNDROME  徐州医学院麻醉学系危重病医学教研室　孟雷 概述 DAD: diffuse alveolar damage（弥漫性肺泡损害） 　Etiology: shock, infection, trauma, aspiration, drugs, inhalation etc. ALI ARDS: a syndrome of pulmonary vasoconstriction, inflammation and greater permeability of both the alveolar capillary endothelium and epithelium that results in both arterial hypoxemia, resistant to oxygen therapy and the appearance of diffuse infiltrates on chest X-rays. Synonyms for Acute(adult) Respiratory Distress Syndrome Adult hyaline membrane disease Adult respiratory insufficiency syndrome Congestive atelectasis Da Nang lung Hemorrhagic atelectasis Hemorrhagic lung syndrome Hypoxic hyperventilation Postperfusion lung Post-traumatic atelectasis Post-traumatic pulmonary insufficiency Progressive pulmonary consolidation Progressive respiratory distress Pump lung、Shock lung Transplant lung Traumatic wet lung、Wet lung、White lung ALI ARDS 病理生理改变： 　急性肺损伤反应，肺泡的弥漫性损害（血管内皮和肺泡上皮细胞的损伤，肺泡的实变，成纤维细胞的增生和胶原纤维的沉着）。 ALI ARDS CLINICAL　FEATURES（临床表现） 呼吸急促，呼吸音改变 进行性呼吸困难，低氧血症 双侧肺部浸润影 心动过速等 ALI ARDS ALI ARDS ARDS is not a single disease, but rather a pathophysiologic syndrom. §1. 病因 etiology Sepsis MODS Trauma Aspiration(误吸) Blood transfusion etc. §2. 病理生理 pathophysiology 基本病理改变： acute exudative phase proliferative phase chronic fibrotic phase PATHOPHYSIOLOGY 非心源性高通透性肺水肿 　Non-cardiac pulmonary edema with increased permeability 肺呼吸功能改变 　Changes of lung respiratory function 肺循环功能改变 　Changes of lung circulatory function PATHOPHYSIOLOGY Inflammatory Response Inflammatory Mediators in ARDS Cytokines Interleukins Tumor necrosis factor Interforns Complement proteins Contact activation proteins Bradykinin Coagulation proteins Thrombin Fibrin degradation products PATHOPHYSIOLOGY Pulmonary edema formation and microcirculatory injury: PATHOPHYSIOLOGY Histologic changes Surfactant Alteration Lung mechanics and Gas exchange Extrapulmonary organ fai