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肺内疾病和肺外疾病引起的成人呼吸窘迫综合征(ARDS)可能并不相同,至少在ARDS早期,不同病因ARDS的呼吸系统力学特性并不一样。作者假设肺本身直接受损导致ARDS(ARDSp)的主要病理变化是肺组织实变,肺外疾病间接引起肺损害的ARDS(ARDSexp)则主要是肺间质水肿和肺泡塌陷。ARDSp早期用PEEP只能使肺中度恢复,弹性(elastance)稍改善,但可能引起肺泡过度膨胀;ARDSexp早期用PEEP可使肺明显改善,顺应性也增进。为进一步了解二者异同,作者选择21例,其中肺炎11例,出血性肺泡炎1例为ARDSp组(n=12);ARDSexp组(n=9),病因为多处伤、肠梗死、腹膜炎、出血性休克等。诊断ARDS均符合美国-欧洲ARDS会议共同统一的标准:①急性发病;
Adult respiratory distress syndrome (ARDS) may be caused by both intrapulmonary and extrapulmonary diseases and may be different at least in the early stages of ARDS due to the different respiratory mechanics of ARDS. The authors hypothesized that the direct pathological changes in the ARDS (ARDSp) caused by direct damage to the lungs are consolidation of the lung tissue and ARDS (indirectly induced lung damage due to extrapulmonary disease) are mainly interstitial lung edema and alveolar collapse. In the early stage of ARDSp, PEEP could only restore moderate lung function and slightly improve the elasticity, but it may cause excessive expansion of the alveolus. In the early stage of ARDSexp, PEEP could obviously improve lung function and improve compliance. To further understand the similarities and differences between the two, the authors selected 21 cases, of which 11 cases of pneumonia and 1 case of hemorrhagic alveolitis ARDSp group (n = 12); ARDSexp group (n = 9), the cause of multiple injuries, intestinal infarction, peritonitis , Hemorrhagic shock and so on. ARDS diagnosis are in line with the United States - the European ARDS common standards: ① acute onset;