西安交通大学医学院呼吸系统疾病课件 ACUTE LUNG INJURY AND ACUTE RESPIRATORY DISTRESS SYNDROME.pptVIP

ACUTE LUNG INJURY AND ACUTE RESPIRATORY DISTRESS SYNDROME Shi Zhi Hong Definition ARDS is a form of acute lung injury often seen in previously healthy patients, It is characterized by rapid respiratory rates, a sensation of profound shortness of breath, severe hypoxemia not responsive to supplemental oxygen (PaO2/FiO2200), and widespread pulmonary infiltrates ( involvement of three of six lung regions) not explained by cardiovascular disease or volume overload . The functioning lung tends to be small, which is indicated by a diminished thoracic gas volume of air that can enter the lung at usual pressures . Etiology Disorders associated with adult respiratory distress syndrome Aspiration Gastric contents Fresh and salt water Central nervous system Trauma Anoxia Drug overdose or reactions Acetylsalicylic acid Heroin Hematologic alterations Disseminated intravascular coagulation Massive blood transfusion Infection Sepsis (gram-positive or –negative) Pneumonia—bacterial, viral, fungl Tuberculosis Inhalation Oxygen Smoke Corrosive chemicals Metabolic disorders Pancreatitis Shock Trauma Fat emboli Pathogenesis and pathophysiology All kinds of severe injury inflammatory response (distant or local tissue injury ) inflammatory mediator ( cytokines, arachidonic acid and PAF, ILs, TNFα) inflammatory cells (neutrophils, pulmonary macrophages ) oxygen radical (O2·—) and protease (local or distant) pulmonary endothelial cell injury V. Clinical manifestation A. Latent period (潜伏期): within 2-3 days after the underlying disease B. Symptoms: i. Increased respiratory rate and respiratory distress: R28 /min ii. Cough and expectoration: blood-tinged sputum iii. Altered mental status: anxiety, fidget, confusion, unconsciousness, C. signs: i. Cyanosis: the most important sign ii. Rales: moist rales, and/ or rhonchi iii. Heart rate: usually 100/min VI. Lab