Shock lung: a distinctive nonentity.
Shock lung: a distinctive nonentity.
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休克肺：一种独特的无足轻重的东西。
作者：
A. Fishman
到第二次世界大战结束时，一种“湿肺”综合症已经被发现，这种疾病会导致危及生命的呼吸窘迫，出乎意料地中断了战斗中出血和创伤性休克的恢复期。在最近的越南战争中，随着战场上循环系统崩溃后的抢救率增加，这种综合症变得更加熟悉，但有了新的名字。因此，“湿肺”、“休克肺”或“岘港肺”成为循环衰竭成功复苏后肺衰竭的同义词。但不管叫什么，顺序都是一样的：在战斗中严重的非胸部损伤、失血和低血压；在战场上使用止血带、输血和阿片类药物成功复苏；迅速后送至先进的医疗设施，以便进行更审慎的管理；几天后，由于呼吸窘迫和衰竭，恢复期被灾难性地中断了。只有少数到达医院的患者出现了休克性肺，但在那些到达医院的患者中，进化的模式是一致的：潜伏的快速浅呼吸，呼吸困难和咳嗽；胡言乱语；耐火材料黄萎病。x线表现为肺间质和肺泡浸润不断扩大并合并，直至整个肺被弥漫性薄雾包围。富氧混合物和辅助通气在达到可容忍的氧合水平方面变得越来越不有效。最后，因呼吸功能不全而死亡，常伴有循环衰竭的复发。在尸检中，一种刻板的病态解剖：血管充血，
B Y THE CLOSE of World War II, a syndrome of "wet lung" had been identified in which life-threatening respiratory distress unexpectedly interrupted convalescence from hemorrhagic and traumatic shock incurred during combat. During the recent war in Vietnam, as the salvage rate after circulatory collapse on the battlefield increased, the syndrome became even more familiar, but under new eponyms. Thus, "wet lung," "shock lung," or "DaNang lung" became synonyms for lung failure that followed successful resuscitation from circulatory collapse. But no matter what it was called, the sequence was the same: severe nonthoracic injury, blood loss, and hypotension during combat; successful resuscitation using tourniquets, transfusions, and opiates on the battlefield; prompt evacuation to a sophisticated medical facility for more deliberate management; and then, a few days later, the calamitous interruption of convalescence by progressive respiratory distress and failure. Only a few who reached the hospital developed shock lung, but in those who did, the pattern of evolution was consistent: insidious onset of rapid shallow breathing, breathlessness, and productive cough; rales and wheezes; refractory cyanosis. Xray appearance of enlarging interstitial and alveolar infiltrates continued to extend and to coalesce until the entire lung was enveloped in a diffuse haze. Enriched oxygen mixtures and assisted ventilation became less and less effective in achieving tolerable levels of oxygenation. Finally, death resulted from respiratory insufficiency often complicated by the recurrence of circulatory collapse. And, at autopsy, a stereotyped morbid anatomy: vascular congestion,