急性肺损伤与急性呼吸窘迫综合征9jtcq.ppt

* * Normally ventilation and perfusion are reasonably well matched * * It is a form of ventilation-perfusion mismatch in which alveoli which are not ventilated (eg due to collapse or pus or oedema fluid) are still perfused. Because the alveoli are not ventilated blood perfusing these alveoli remains poorly oxygenated, with the result that blood leaving the lungs is not fully saturated. * * Furthermore oxygen therapy has relatively little effect on hypoxia due to shunting. Increasing the inspired oxygen concentration cannot further increase the saturation of blood leaving normally ventilated alveoli as it is already 100% saturated and the higher oxygen concentration does not reach non-ventilated alveoli * * Causes of intrapulmonary shunting include pneumonia, pulmonary oedema, atelectasis, collapse and pulmonary haemorrhage or contusion Shunting can also occur at an intra-cardiac level but this is an unusual cause of hypoxaemia in the ICU. Any cause of pulm hyptension eg ARDS with patent foramen ovale can lead to right to left shunting. * * This occurs when alveoli are ventilated but not perfused * * 弥散面积减少： 肺实变、肺不张、肺切除术后 肺泡毛细血管膜增厚：肺纤维组织增生、肺水肿 血液流经肺毛细血管的时间太短：肺气肿时肺毛细血管随肺泡壁破坏而? 肺毛细血管弥散血量减少：贫血、血容量过低、肺血管收缩 * * * * Carbon dioxide removal is largely dependent on alveolar ventilation which, in turn, is dependent on the respiratory rate times the difference between tidal volume and dead space. The latter will vary, depending on ventilation perfusion matching * * For patients with respiratory failure which is predominantly due to shunting CPAP may improve oxygenation dramatically by re-opening and keeping open collapsed alveoli * * 急性肾衰竭（acute renal failure, ARF） 肾小球滤过功能在数小时至数周内迅速降低而引起的以水，电解质和酸碱平衡失调以及含氮废物蓄积为主要特征的一组临床综合症。 少尿型和非少尿型。 少数患者可无症状，仅血尿素氮（BUN）和血清肌酐（Scr）升高。 * 近年来不需要透析支持发病率由322.7/100000增加到522.4/100000；需要透析的发病率由19.5/100000增加到29.5/100000。 * * 广义上讲包括肾前性、肾性、肾后性三种类型，狭义上讲ARF即指急性肾小管坏死（ATN）。 * 1.急性血容量不足 ⑴ 消化道失液：如呕吐腹泻。 ⑵ 各种原因引起的大出血。 ⑶ 皮肤大量失液：如中暑及大量出汗。 ⑷ 第三间隙失液：如大面积烧伤、腹膜炎、坏死