新生儿急性肺损伤的诊断与治疗策略

急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS)是新生儿临床的常见危重症,随着对ALI/ARDS实验与临床研究的不断深入,人们对新生儿ALI/ARDS的认识明显提高,文章提出了新生儿ALI/ARDS诊断依据与治疗策略,在控制原发疾病基础上,应用肺保护性通气策略、加强液体管理、降低肺动脉压力和给予抗炎治疗等,对提高新生儿ALI/ARDS抢救成功率具有重要意义.     

新生儿急性肺损伤

急性肺损伤（ALI）是指机体在遭受各种病理刺激后发生的急性炎症反应，以急性弥散性肺泡上皮细胞损伤及肺泡毛细血管内皮细胞损伤为主要病理变化，临床上表现为进行性呼吸困难和难以纠正的低氧血症。ALI是一个连续的病理过程，而急性呼吸窘迫综合征（ARDS）是这一病理过程的最严重阶段，也是最终病理结局，即所有ARDS都经过ALI，而ALI不一定都发展成ARDS。     

危重患儿急性肺损伤

儿童急性肺损伤(acute lung injury,ALI)或急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是指由心源性以外的各种肺内外因素引起的急性、进行性缺氧性呼吸衰竭。ALI和ARDS为同一疾病过程的两个阶段,即ALI为早期、病情较轻阶段,ARDS为后期、病情严重阶段。ALI/     

小儿肺炎并急性肺损伤

急性肺损伤(acutelunginjury ,ALI)是一个以肺部炎症和肺泡毛细血管通透性增加为特征的临床综合征。病理特点为弥散性肺泡毛细血管膜损伤,X线胸片示弥散性浸润影,临床表现为难以纠正的低氧血症。ALI是一个连续的病理过程,而急性呼吸窘迫综合征(acuterespiratorydistresssyn dro     

新生儿急性肺损伤

20世纪 90年代 ,人们对急性呼吸窘迫综合征 (ARDS)的认识逐步深化 ,提出了急性肺损伤 (ALI)的概念 ,认为ALI与ARDS同属于一个病理生理过程 ,ARDS是ALI发展的严重阶段 ,并认识到ALI/ARDS是全身炎症反应综合征 (SIRS)在肺部的表现 ,是致炎和抗炎之间平衡失调的结果。但有关新生儿ALI/ARDS的研究起步较晚 ,本文就近年来有关新生儿ALI/ARDS的临床和基础研究加以综述。1　新生儿ALI/ARDS存在的依据1 1　临床研究　新生儿由于 :①在各种肺损伤因素作用前很难确定其肺是否发育正常和成熟 ;②新生儿期的许多疾病 ,如新生儿肺…     

高频振荡通气治疗足月新生儿急性呼吸窘迫综合征

新生儿急性呼吸窘迫综合征（acute respiratory distress syndrome,ARDS）不同于早产儿肺透明膜病（hyaline membrane disease,HMD）,是新生儿危重急症之一。在国外新生儿重症监护病房中病死率较高。上世纪90年代对ARDS有了逐步深入的认识,并提出了急性肺损伤（acute lung injury．ALI）的概念,认为ALI和ARDS同属于一个病理生理过程,ARDS是ALI发展的严重阶段,是全身炎症反应综合征（SIRS）在肺部的表现。     

新生儿急性肺损伤中几个问题的思考

自1962年Ashbangh等首次报道急性呼吸窘迫综合征（acute respiratory distress syndrome,ARDS）以来,随着对ARDS基础与临床研究的不断深入,人们发现ARDS是急性肺损伤（acute lungin jury,ALI）连续病理过程中最严重的阶段,所有的ARDS均经过ALI,而ALI不一定都发展成ARDS,     

急性弥散性肺部疾病与急性肺损伤

近年来,急性起病,表现为呼吸困难、发绀,影像学显示肺部弥散性病变的病例逐渐增多。此类疾病有免疫机制参与,起病急,常有呛咳,呼吸急促、困难,伴中度发热,肺存在广泛细湿音和其他干湿音,胸部X线和CT显示广泛肺间质、实质或气道异常病变。这些病例的原发病诊断困难,缺乏客观的金标准,有些病因不明,教科书和文献对疾病归类也存在分歧。按其临床表现也符合急性肺损伤(acutelunginjury ,ALI)或急性呼吸窘迫综合征(acuterespiratorydistresssyndrome,ARDS)诊断标准,但未存在严重感染和ARDS发病高危因素。此类病例是否诊断为ALI/ARDS…     

炎症反应综合征与急性肺损伤

急性肺损伤（ALI）是指创伤、感染等原因引起的急性肺组织细胞的弥漫性损伤[1]。目前不少教科书和文献将ALI和急性呼吸窘迫综合征（ARDS）归为同类疾病的两个概念。实质上,ALI与ARDS的病理改变性质相似而程度不同而     

急性肺损伤时损伤标志物的研究进展

急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）是指心源性以外的各种肺内外致病因素导致的急性的、进行性的呼吸衰竭。ALI阶段若未给予有效的治疗干预则可能进展为ARDS,由于ARDS发病机制复杂,治疗效果不佳,其病死率仍然居高不下。目前ALI仍然缺乏有效的治疗方法,因而针对ALI发病机制及早期诊断方法的研究显得尤为重要。本文将就ALI时损伤标志物的相关研究进行综述,为ALI的早期诊断及以后的相关研究打下基础。     

Acute glomerulonephritis

Acute glomerulonephritis (AGN) manifests with abrupt onset of hematuria, facial edema, hypertension and impairment of renal function. The commonest form of AGN in developing countries is that following a beta hemolytic streptococcal infection where the glomerular injury is mediated by deposition of immune complexes. In the usual patient with moderately severe poststreptococcal AGN (PSAGN) the above-mentioned features are present However, gross or microscopic hematuria may be the only abnormality. A similar picture may occasionally be produced by a variety of infections (when GN is referred to as post-infectious and the mechanism of glomerular damage and the renal histology are similar to that in PSAGN), primary renal glomerular disorders (eg. membranoproliferative GN, IgA nephropathy), collagen vascular diseases (systemic lupus erythematosus), systemic vasculitis (Henoch Schonlein purpura) and hereditary nephritis and some nonglomerular conditions. PSAGN may also present with one or more of its complications such as profound volume expansion with heart failure and hypertensive encephalopathy. PSAGN resolves rapidly and has an excellent prognosis. Patients with severe renal involvement and life threatening complications need expert supportive management. AGN with associated systemic features or very pronounced azotemia, nonstreptococcal AGN and unresolving GN need prompt, appropriate evaluation that often includes a renal biopsy. If extensive crescentic changes are found (crescentic GN), aggressive immunosuppression will be necessary.     

Acute myocarditis

Myocarditis is defined as inflammation of the myocardium accompanied by myocellular necrosis. Acute myocarditis must be considered in patients who present with recent onset of cardiac failure or arrhythmia. Often there is a history of an antecedent flu-like illness. Fulminant myocarditis is a distinct entity characterized by sudden onset of severe congestive heart failure or cardiogenic shock, usually following a flu-like illness. Giant cell myocarditis is a rare, frequently fatal disorder of unknown origin characterized by presence of giant cell inflammatory infiltrate in the myocardium. In recent years we have made good progress in understanding the causes, pathogenesis, natural history, diagnosis, and treatment of myocarditis. However, our knowledge is still far from complete. New information that extends our understanding of myocarditis is being reported constantly. This review summarizes recent advances in myocarditis, with an emphasis on the literature during the last year.