Lung pathology in respiratory distress following shock in the adult.
Lung pathology in respiratory distress following shock in the adult.
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成人休克后呼吸窘迫的肺部病理学。
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发表时间：
2009
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通讯作者：
S. Orell
中科院分区：
文献类型：
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作者：
S. Orell
本文回顾了20例因创伤、手术后并发症或严重急性疾病引起休克的成人进行性呼吸窘迫（PRD）。肺实变与肺透明膜（HM）的形成在这些情况下的发展进行了详细描述。如果存活时间足够长，HM的机化可能导致呼吸性细支气管和肺泡管的纤维闭塞。这是一幅很有特色的画。在另外12例接受人工通气治疗的病例中发现了无组织的薄HM，解释为早期病变;这些患者未发生PRD，但死于其他原因。病理结果的关系，某些临床因素，如生存时间与PRD，持续时间的机械通气和氧浓度，进行了研究。这些结果似乎与以下理论相一致，即肺损伤是由组织灌注不足以及休克期间可能的血管内凝血引起的，从而导致内皮损伤和肺泡表面活性物质减少。可能有许多重要的促成因素，如人工通气的机械作用、高氧浓度、感染等。“呼吸窘迫肺”似乎是这类肺部病变的一个适当的形态学术语，它也可能由尿毒症和病毒性肺炎引起，例如，与新生儿的肺透明膜病非常相似。
Twenty cases of progressive respiratory distress (PRD) in adult patients following shock in connection with trauma, post-operative complications or serious acute diseases are reviewed. The development of pulmonary consolidation with the formation of hyaline membranes (HM) in these cases is described in detail. Organization of the HMs may result in fibrous obliteration of respiratory bronchioles and alveolar ducts, if survival is sufficiently long. This is a highly characteristic picture. Thin HMs without organization, interpreted as early lesions, were found among twelve additional cases treated by artificial ventilation; these patients did not develop PRD but died of other causes. The relation of the pathological findings to certain clinical factors, such as length of survival with PRD, duration of mechanical ventilation and oxygen concentration, has been investigated. The results seem to concur with the theory that the pulmonary lesions are precipitated by inadequate tissue perfusion and possibly also intravascular coagulation during shock, leading to endothelial damage and reduced alveolar surfactant. Probably there are many important contributary factors, such as the mechanical effects of artificial ventilation, high oxygen concentration, infection, etc. “The respiratory distress lung” seems to be an appropriate morphological term for this type of lung lesion, which may also be precipitated by uraemia and viral pneumonia, for example, and greatly resembles the hyaline membrane disease in the newborn.