【呼吸系统学习】-呼吸衰竭3.ppt

Figure 1. Radiographic and Computed Tomographic (CT) Findings in the Acute, or Exudative, Phase (Panels A and C) and the Fibrosing- Alveolitis Phase (Panels B and D) of Acute Lung Injury and the Acute Respiratory Distress Syndrome. Panel A shows an anteroposterior chest radiograph from a 42-year-old man with the acute respiratory distress syndrome associated with gram-negative sepsis who was receiving mechanical ventilation. The pulmonary-artery wedge pressure, measured with a pulmonary- artery catheter, was 4 mm Hg. There are diffuse bilateral alveolar opacities consistent with the presence of pulmonary edema. Panel B shows an anteroposterior chest radiograph from a 60-year-old man with acute lung injury and the acute respiratory distress syndrome who had been receiving mechanical ventilation for seven days. Reticular opacities are present throughout both lung fields, a finding suggestive of the development of fibrosing alveolitis. Panel C shows a CT scan of the chest obtained during the acute phase. The bilateral alveolar opacities are denser in the dependent, posterior lung zones, with sparing of the anterior lung fields. The arrows indicate thickened interlobular septa, consistent with the presence of pulmonary edema. The bilateral pleural effusions are a common finding. 14,15 Panel D shows a CT scan of the chest obtained during the fibrosing-alveolitis phase. There are reticular opacities and diffuse ground-glass opacities throughout both lung fields, and a large bulla is present in the left anterior hemithorax. Panels C and D are reprinted from Goodman 16 with the permission of the publisher. 七、诊断 1994年欧美联席会议急性肺损伤(ALI)和ARDS诊断标准： 急性肺损伤（acute lung injury, ALI）诊断标准： ①急性起病； ②PaO2/FiO2≤300mmHg（不管PEEP水平）； ③胸片示双肺纹理增多，边缘模糊，斑片状或大片状密度增高影等间质性或肺泡性水肿、浸润影； ④PCWP≤18mmHg,或无左心房压力增高的临床证据。 ARDS：PaO2/FiO2≤200mmHg，其它项目均与ALI相同, 但其临床表现比ALI严重。 欧美诊断标准(Am J Respir Crit Care Med 1994) Diagnostic Criteria for Acute Lung Injury(ALI)and ARDS Onset Oxygena