ARDS与肺复张.ppt

* 急性呼吸窘迫综合征是指肺内、外严重疾病导致以肺毛细血管弥漫性损伤、通透性增强为基础，以肺水肿、透明膜形成和肺不张为主要病理变化，以进行性呼吸窘迫和难治性低氧血症为临床特征的急性呼吸衰竭综合征。 * * 基本病理生理改变是肺泡上皮和肺毛细血管内皮通透性增加所致的非心源性肺水肿。 * Light micrograph of diffuse alveolar damage, as can occur in the acute respiratory distress syndrome. The alveolar septa are edematous but without acute inflammation. Hyaline membranes are lining the alveolar spaces (arrow), and alveolar hemorrhage is present. Courtesy of Marvin I Schwarz, MD * Schematic representation of the time course of the acute respiratory distress syndrome (ARDS). During the early (or exudative) phase, the lesion is characterized by high permeability pulmonary edema followed by the formation of hyaline membranes. After seven to ten days, a proliferative phase may develop, with marked interstitial inflammation, fibrosis, and disordered healing. Redrawn from Katzenstein AA, Askin FB. Surgical Pathology of Non-neoplastic Lung Disease. Saunders, Philadelphia, 1982. Graphic 77051 Version 1460.0 * * * * * * Transmural = Passing through a wall Macroscopic aspect of rat lungs after mechanical ventilation at 45 cm H2O peak airway pressure.?Left: normal lungs;?middle: after 5 min of high airway pressure mechanical ventilation. Note the focal zones of atelectasis (in particular at the left lung apex);?right: after 20 min, the lungs were markedly enlarged and congestive; edema fluid fills the tracheal cannula.Read More:?/doi/full/10.1164/ajrccm.157.1.9604014 * Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med 2000; 342:1301-8.?[Full text]?(PMID BACKGROUND: Traditional approaches to mechanical ventilation use tidal volumes of 10 to 15 ml per kilogram of body weight and may cause stretch-induced lung injury in patients with acute lung injury and the acute respiratory distress syndrome. We therefore conducted a trial to determine whether ven