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急性肺损伤(acute lung injury，ALI)、急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)是指由非静水压原因所导致的肺部一系列病理生理改变继而引起急性、进行性缺氧性呼吸衰竭。ALI和ARDS不是孤立、相互分割的疾病，它们是严重损伤引起机体全身免疫炎征反应失控过程中的不同阶段。从损伤→全身炎症反应综合征     

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随着普外科老年病人的日愈增多与病种的日愈复杂，合并急性肺损伤(acute lung injury，ALI)的概率也在增加，已成为外科危重病人监护室(SICU)中救治的主要问题，其治疗是否及时与正确常影响病人的最终结局。     

肝切除术后急性肺损伤和呼吸窘迫综合征的诊治

我科于2000年1月至2003年1月共行原发性肝癌肝切除术516例，术后发生急性肺损伤(acute lung injury，ALI)7例，急性呼吸窘迫综合征(ARDS)2例。发生率为1．74％(9／516)。现统计分析9例临床病例资料，以了解其发病规律，总结肝切除术后ALI和ARDS的预防和治疗体会。     

预防性治疗重症急性胰腺炎合并肺损伤的体会

重症急性胰腺炎 ( severe acute pancreatitis,SAP)可以引起全身炎症性反应综合征 ( systemicinflammatory response syndrome,SIRS) ,并进一步出现包括肺、心、肝、肾及循环系统等损伤 ,甚至衰竭而至患者死亡 [1] 。这其中 ,急性呼吸窘迫综合征 ( a-cute respiratory distress syndrome,ARDS)是 SAP的主要并发症之一 ,其死亡率高达 5 0 % [2 ]。目前研究认为 ,ARDS患者肺部的损伤是持续炎症分子学机制[3 ] 。如何抑制过度炎症反应成为 ARDS预防性治疗关键。我们自 1 996年 2月～ 2 0 0 1年 1 2月采取乌司他丁 ( UTI)联合大剂量激…     

粘附分子与ARDS

粘附分子是介导细胞与细胞、细胞与细胞外间质粘附作用的细胞膜表面的糖蛋白。近年的研究表明粘附分子与急性呼吸窘迫综合征(ARDs)的发生、发展有着密切关系。本文就粘附分子的种类、特性及其在ARDS的发病过程中的作用特点、作用机制作一综述。     

肺表面活性物质对"二次打击"致大鼠急性肺损伤的作用

全身炎性反应综合征（SIRS）是严重创伤病人的主要死亡原因之一。当机体受到创伤、烧伤、大失血后，若继发感染、肠道细菌移位常常可以引起SIRS，从而导致急性肺损伤（Au）或急性呼吸窘迫综合征（ARDS），甚至多器官功能障碍综合征。肺表面活性物质功能异常在ALI／ARDS中起着非常重要的作用。本研究拟观察肺表面活性物质对急性失血性休克合并肺内毒素（LPS）感染“二次打击”致大鼠ALI的作用。     

雾化吸入前列腺素E1对盐酸所致急性肺损伤的影响

目的 探讨雾化吸入前列腺素E1(PGE1)对盐酸所致急性肺损伤(ALI)循环及呼吸功能的影响。方法 18头健康家猪,麻醉及相关操作后记录平均动脉压(MAP)、平均肺动脉压(MPAP)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)及肺顺应性作基础值,经气管导管向肺内注入0.1mol/L的盐酸溶液,直至PaO2<13.3 kPa并持续30 min,记录上述指标。随机分为A、B、c三组,每组6头。A组只接受机械通气无呼气末正压(PEEP),B组与A组同,但附加PEEP,C组在B组的基础上雾化吸入PGE1,观察4 h,每1 h记录上述指标一次。实验结束后开胸取肺并做组织学检查。结果 三组MAP在ALI后均明显下降,并维持在12 kPa左右,组间未见差异(P>0.05)。三组MPAP在ALI后明显升高,A、B两组MPAP一直保持在(4.24±0.52)kPa以上,组间无差异(P>0.05),而C组则明显下降至(3.42±0.31)kPa以下,与A、B组比较呈差异有显著性(P<0.05)。B、C两组的PaO2在分组后均较A组的明显升高(P<0.05),以C组最明显。B、C组肺顺应性明显高于A组(P<0.05)。肺组织切片显示C组的肺组织损伤明显较A、B组轻,B组也轻于A组。结论 雾化吸入PGE,能改善盐酸所致ALI的呼吸功能,并在维持MAP平稳的情况下降低肺动脉压。     

ARDS呼吸力学变化的动态观察

ＡＲＤＳ呼吸力学变化的动态观察蹇华胜＊毕敏＊龙子善本研究通过连续动态观察１１例ＡＲＤＳ的呼吸力学变化，旨在探讨其变化规律以及对ＡＲＤＳ的早期诊断、疗效评估和预后推测的临床意义。资料和方法一、病例选择与分组本组连续观察ＡＲＤＳ患者１１例。诊断按１９８８...     

腹内压对急性肺损伤／急性呼吸窘迫综合征患者氧合的影响及意义

急性肺损伤／急性呼吸窘迫综合征（ALUARDS）是一种常见的危重症,病死率高达30％-50％。引起ALI／ARDS常见病因,往往也造成患者腹内压（IAP）的变化E23。而IAP升高也可影响呼吸、循环、中枢神经系统等的生理功能．严重时导致多器官功能障碍,即腹腔间隔室综合征（ACS）Ⅲ。在这些影响中,IAP升高对呼吸系统的影响表现最早。本文旨在评价在ALI／ARDS患者中腹内压（I—AP）和气道平均压（mPaw）的相关性以及IAP对ALI／ARDS患者氧合功能的影响。     

急性肺损伤/急性呼吸窘迫综合征液体治疗策略

背景 高通透性肺水肿是急性肺损伤/急性呼吸窘迫综合征(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)的基本病理生理特征,其程度与ALI/ARDS的预后密切相关.目的 对ALI/ARDS患者合理的液体管理,有助于改善ALI/ARDS患者的肺水肿,降低该病病死率.内容 回顾了ALI/ARDS液体治疗策略探索过程中存在争议的问题(如限制性或开放性的液体治疗策略及治疗液体种类的选择),总结了该领域近年来的研究进展(如ALI/ARDS病程不同阶段的差异化治疗及液体治疗的监测指标).趋向 今后将进一步探索该病在不同的病理生理状态下特异性的液体治疗方法,寻求高效敏感的监测指标,指导液体治疗策略的选择和调整.     

Prone positioning ventilation for treatment of acute lung injury and acute respiratory distress syndrome

Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care work-ers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxy-genation without use of expensive, invasive and experimen-tal procedures.     

Optimal ventilator settings in acute lung injury and acute respiratory distress syndrome

Despite recent advances in intensive care medicine, acute lung injury and its more severe form, acute respiratory distress syndrome pose major therapeutic problems. While mechanical ventilation is integral to the care of these patients, its adverse consequences including ventilator-induced lung injury are determinants of disease progression and prognosis. Among several important ventilator parameters, the use of low tidal volumes is probably the most important feature of lung-protective mechanical ventilation. Intensivists should be trained to recognize acute lung injury and acute respiratory distress syndrome and encouraged to use low-tidal-volume ventilation in clinical practice. Alternative modes of ventilation such as high-frequency ventilation and prone position should be reserved for selected patients in whom conventional lung-protective ventilation strategies have failed.     

肝移植术后急性肺损伤/急性呼吸窘迫综合征的研究进展

急性肺损伤/急性呼吸窘迫综合症（ALI/ARDS）是肝移植术后常见的并发症,可延长受者术后重症监护室入住时间,影响肝移植手术疗效,病情严重可致受者死亡,临床中引起了肝移植外科医师的高度重视。肝移植术后ALI/ARDS可由肺源性因素（例如机械通气相关肺损伤、肺部感染、误吸等）直接导致,也可由非肺源性因素（例如肺部以外的严重感染、输血、缺血-再灌注损伤等）间接导致。本文对肝移植术后ALI/ARDS的诊断标准及发生情况、发生机制、危险因素、实验室及临床诊断方法以及治疗方法等进行综述,加深对肝移植围手术期ALI/ARDS的理解与认知,以期为肝移植术后ALI/ARDS的诊治提供借鉴。     

Right ventricular failure in acute lung injury and acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a clinical entity involving not only alveolar lesions but also capillary lesions, both of which have deleterious effects on the pulmonary circulation, leading to constant pulmonary hypertension and to acute cor pulmonale (ACP) in 20-25% of patients ventilated with a limited plateau pressure (Pplat). Considering the poor prognosis of patients suffering from such acute right ventricular (RV) dysfunction, RV protection by appropriate ventilatory settings has become a crucial issue in ARDS management. The goal of this review is to emphasize the importance of analyzing RV function in ARDS, using echocardiography, in order to limit RV afterload. Any observed acute RV dysfunction should lead physicians to consider a strategy for RV protection, including strict limitation of Pplat, diminution of positive end-expiratory pressure (PEEP) and control of hypercapnia, all goals achieved by prone positioning.     

Acute lung injury and acute respiratory distress syndrome after pulmonary resection

BACKGROUND: In this study we investigate the frequency and mortality of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) after pulmonary resection. METHODS: Patients that underwent pulmonary resection at the Royal Brompton Hospital between 1991 and 1997 were included. The case notes of all patients developing postoperative complications were retrospectively reviewed. RESULTS: The overall combined frequency of ALI and ARDS was 3.9%. The frequency was higher in patients over 60 years of age, males and those undergoing resection for lung cancer. ALI/ARDS caused 72.5% of the total mortality after resection in this series. CONCLUSIONS: In our experience ALI and ARDS are major causes of mortality after lung resection.     

Acute lung injury and acute respiratory distress syndrome after pulmonary resection

The occurrence of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) after thoracic surgery are perplexing and persistent problems. Variously described as postpneumonectomy pulmonary edema, noncardiogenic pulmonary edema, and postlung resection pulmonary edema, ALI and ARDS may be considered a single entity, with ALI being the less severe form of ARDS. It is characterized by the acute onset of hypoxemia with radiographic infiltrates consistent with pulmonary edema, without elevations in the pulmonary capillary wedge pressure. Although this syndrome does not occur frequently and is usually without identifiable cause, the mortality is high. However, the phenomenon has not been rigorously studied owing to the low incidence, with primarily retrospective case series reported. Thus, the nomenclature, risks, and pathogenesis are not well defined. Interest in this syndrome has recently been renewed as the rate of other perioperative complications has declined. ALI/ARDS is reviewed with a focus on potential etiologies and the spectrum of available interventions.