Alveolar edema fluid clearance and acute lung injury
Alveolar edema fluid clearance and acute lung injury
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DOI：
10.1016/j.resp.2007.05.010
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发表时间：
2007-12-15
影响因子：
2.3
通讯作者：
Matthay, Michael A.
中科院分区：
文献类型：
--
作者：
Berthiaume, Yves;Matthay, Michael A.
尽管肺保护性通气策略大大降低了急性肺损伤患者的死亡率，但仍需要新的治疗方法来进一步降低急性肺损伤患者的死亡率。上皮离子和液体在远端肺上皮上的运输研究为急性肺损伤的潜在新疗法提供了重要的新概念。总的来说，有令人信服的证据表明，肺泡上皮不仅是一个紧密的上皮屏障，可以抵抗水肿液进入肺泡，而且还积极参与离子和溶质的运输，这一过程对于水肿液的清除和急性肺损伤的解决至关重要。本文的目的是考虑在正常和病理条件下肺泡液运输领域的一些最新进展。通过肺泡和远端气道上皮的矢量离子运输是肺泡液清除的主要决定因素。一般的模式是活跃的Na+和Cl-运输驱动净肺泡液清除，这在包括人类肺在内的几种不同物种中得到证实。尽管这些转运过程可能在严重肺损伤中受损，但多项实验研究表明，上调Na+和Cl-转运可能是急性肺损伤的有效治疗方法。我们将回顾涉及肺损伤中离子转运的药理学调节机制，特别关注β -肾上腺素能激动剂的使用，这已经引起了相当大的兴趣，并且是临床急性肺损伤的一种有前景的治疗方法。(C) 2007 Elsevier B.V.版权所有
Although lung-protective ventilation strategies have substantially reduced mortality of acute lung injury patients there is still a need for new therapies that can further decrease mortality in patients with acute lung injury. Studies of epithelial ion and fluid transport across the distal pulmonary epithelia have provided important new concepts regarding potential new therapies for acute lung injury. Overall, there is convincing evidence that the alveolar epithelium is not only a tight epithelial barrier that resists the movement of edema fluid into the alveoli, but it is also actively involved in the transport of ions and solutes, a process that is essential for edema fluid clearance and the resolution of acute lung injury. The objective of this article is to consider some areas of recent progress in the field of alveolar fluid transport under normal and pathologic conditions. Vectorial ion transport across the alveolar and distal airway epithelia is the primary determinant of alveolar fluid clearance. The general paradigm is that active Na+ and Cl- transport drives net alveolar fluid clearance, as demonstrated in several different species, including the human lung. Although these transport processes can be impaired in severe lung injury, multiple experimental studies suggest that upregulation of Na+ and Cl- transport might be an effective therapy in acute lung injury. We will review mechanisms involved in pharmacological modulation of ion transport in lung injury with a special focus on the use of beta-adrenergic agonists which has generated considerable interest and is a promising therapy for clinical acute lung injury. (C) 2007 Elsevier B.V. All rights reserved.