资源描述：
《ARDS进展（急性呼吸窘迫综合征）-施焕中.ppt》由会员上传分享，免费在线阅读，更多相关内容在应用文档-天天文库。
1、急性呼吸窘迫综合征NEnglJMed2003;348:683-693.NEnglJMed2003;348:683-693.NEnglJMed2003;348:683-693.MethodsWeevaluated109survivorsoftheacuterespiratorydistresssyndrome3,6,and12monthsafterdischargefromtheintensivecareunit.Ateachvisit,patientswereinterviewedandunderwentaphysicalexaminat
2、ion,pulmonary-functiontesting,asix-minute–walktest,andaquality-of-lifeevaluation.ResultsPatientswhosurvivedtheacuterespiratorydistresssyndromewereyoung(medianage,45years)andseverelyill(medianAcutePhysiology,Age,andChronicHealthEvaluationscore,23)andhadalongstayintheintens
3、ivecareunit(median,25days).Patientshadlost18percentoftheirbase-linebodyweightbythetimetheyweredischargedfromtheintensivecareunitandstatedthatmuscleweaknessandfatiguewerethereasonsfortheirfunctionallimitation.Lungvolumeandspirometricmeasurementswerenormalby6months,butcarbo
4、nmonoxidediffusioncapacityremainedlowthroughoutthe12-monthfollow-up.Nopatientsrequiredsupplementaloxygenat12months,but6percentofpatientshadarterialoxygensaturationvaluesbelow88percentduringexercise.ThemedianscoreforthephysicalroledomainoftheMedicalOutcomesStudy36-itemShor
5、t-FormGeneralHealthSurvey(ahealth-relatedquality-of-lifemeasure)increasedfrom0at3monthsto25at12months(scoreinthenormalpopulation,84).Thedistancewalkedinsixminutesincreasedfromamedianof281mat3monthsto422mat12months;allvalueswerelowerthanpredicted.Theabsenceofsystemiccortic
6、osteroidtreatment,theabsenceofillnessacquiredduringtheintensivecareunitstay,andrapidresolutionoflunginjuryandmultiorgandysfunctionwereassociatedwithbetterfunctionalstatusduringtheone-yearfollow-up.ConclusionsSurvivorsoftheacuterespiratorydistresssyndromehavepersistentfunc
7、tionaldisabilityoneyearafterdischargefromtheintensivecareunit.Mostpatientshaveextrapulmonaryconditions,withmusclewastingandweaknessbeingmostprominent.NEnglJMed2003;348:683-693.定义ALI/ARDS是指由心源性以外的各种肺内外致病因素导致的急性、进行性缺氧性呼吸衰竭。ALI/ARDS具有性质相同的病理生理改变，严重的ALI即被定义为ARDS。ALI/ARDS以肺微血管
8、通透性增加、肺气容积减少、肺顺应性降低和严重肺内分流及通气/血流比例失调为病理生理特点，临床表现为不易缓解的急性进行性缺氧性呼吸衰竭，胸部X线可见肺部浸润征象。高危因素一、直接肺损伤因素严重肺
