手术后急性的肥损伤和ARDS.ppt

O.T.Clagett Lecture.Mayo Clinic. May, 2001 ACUTE LUNG INJURY and ARDS AFTER THORACOTOMY O.T.Clagett Lecture. 6th Belgian Congress of Cardio-Thoracic Surgery. Acute Lung Injury (ALI) and ARDS following lung resection. ARDS Following Thoracotomy. Acute Respiratory Distress Syndrome “Non-cardiogenic Pulmonary Oedema” Ashbaugh, Bigelow et al, 1967 “Adult Respiratory Distress Syndrome” Petty and Ashbaugh, 1971 “Shock Lung” Staub, 1974 “Acute Respiratory Distress Syndrome” - American-European Consensus Committee, 1992 Acute Respiratory Distress Syndrome Severe trauma, blood loss or massive transfusion. - Road Traffic Accidents. - Extensive surgery. Pancreatitis. Post-partum. Multiple fractures and fat embolism. Sepsis. Burns. Acute Respiratory Distress Syndrome Initial “shock” responding to resuscitation. Latent period of hours, usually days. Insidious tachypnoea. Progressive “ground-glass” appearance on chest radiograph. Refractory hypoxaemia. IPPV and multiple system failure. Death! Histological Features. Exudative Phase, 0-5 days. Alveolar spaces filled with fluid, protein and inflammatory cells. Haemorrhage from engorged capillaries. Necrosis of type 1 pneumocytes, fibrin, platelet thrombi. Inflammatory Phase, 5-10 days. Proliferation of fibroblasts and type 2 pneumocytes. Squamous metaplasia and hyaline membranes. Fibroproliferative Phase, 10 days to recovery or death. Interstital and intra-alveolar fibrosis. Thrombosis and vascular obliteration. Increasing lung collagen. Acute Respiratory Distress Syndrome Recognised after oesophagectomy. Always fatal. Prevention important. - ? Related to aspiration. - Minimize fluids during anaesthesia. Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome Post-Pneumonectomy Pulmonary Edema. Incidence of 4-7% after pneumonectomy. 1-7% after lobectomy. Also seen after other thoracic procedures. - Decortica