呼吸衰竭的医学资料.pptVIP

肺不张 正常情况下，无论是吸气还是呼气时，肺内总是含有适量的空气，以保证不间断地进行气体交换。任何原因引起的一部分肺脏含气量显著减少及完全不含气体，并伴肺组织萎陷，体积缩小，就叫做肺不张。肺不张不是一个独立的疾病，可由多种疾病引起， 肺实变 肺实变的急性炎症主要表现为渗出，肺泡内的气体被渗出的液体，蛋白及细胞所代替，而形成实变。多见于各种急性炎症，渗出性肺结核，肺出血及肺水肿。其他如肺梗死，肺泡癌可能有肺段或大叶性实变。 弥散面积减少：正常成人约有3亿个肺泡，总面积为70 m2，静息时参予换气的面积约为40 m2, 故有相当大的贮备面积。呼吸膜弥散面积减少见于：①肺叶切除和肺不张病人，吸气末时扩张的肺泡数量减少；②肺实变时肺泡充满了液体，肺泡内气体与肺泡毛细血管接触的面积减少；③肺气肿时，白细胞和巨噬细胞释放的蛋白水解酶增加，损伤肺组织和肺泡壁，致使多个肺泡融合成肺大泡。 Mortality: 30-40%; survivors: respiratory function recovers within 6-12 months. Background: Ashbaugh and colleagues first described acute respiratory distress syndrome (ARDS) in 1967. They described the syndrome as acute onset of severe respiratory distress, cyanosis (hypoxemia) refractory to oxygen therapy, diffuse abnormalities on chest radiographs (CXRs), and decreased lung compliance. In 1994, the American-European Consensus Conference (AECC) on ARDS formulated their definition of ARDS as follows: Acute onset of symptoms Ratio of PaO2 to the fraction of inspired oxygen (FIO2) of 200 mm Hg or less Bilateral infiltrates on CXRs Pulmonary arterial wedge pressure of 18 mm Hg or less or no clinical signs of left atrial hypertension The radiographic abnormalities of ARDS reflect the leakage of fluid with a high protein content into the alveolar spaces because of alveolar epithelial injury, or diffuse alveolar damage. ARDS is a syndrome defined by its clinical features. It may result from intrathoracic or extrathoracic events of various etiologies, such as inflammatory, infectious, vascular, or traumatic etiologies. Determining the causative event may be clinically important for proper treatment. ARDS is a syndrome that commonly begins after exposure to a known risk factor. Why some people develop ARDS and others do not is still unknown. The risk factors for ARDS include primary pulmonary etiologies (eg, aspiration, pneumonia, toxic inhalation, pulmonary contusion) and extrapulmonary etiologies (eg, sepsis, pancreatitis, multiple blood transfusions, trauma, use of drugs