Puybasset L, Cluzel P, Gusman P, Grenier P, Preteux F, Rouby J J
Department of Anesthesiology, Hôpital de la Pitié-Salpêtrière, University of Paris VI and Institut National des Télécommunications, Evry, France.
Intensive Care Med. 2000 Jul;26(7):857-69. doi: 10.1007/s001340051274.
To compare the computed tomographic (CT) analysis of the distribution of gas and tissue in the lungs of patients with ARDS with that in healthy volunteers.
Prospective study over a 53-month period.
Fourteen-bed surgical intensive care unit of a university hospital.
Seventy-one consecutive patients with early ARDS and 11 healthy volunteers.
A lung CT was performed at end-expiration in patients with ARDS (at zero PEEP) and healthy volunteers. In patients with ARDS, end-expiratory lung volume (gas + tissue) and functional residual capacity (FRC) were reduced by 17% and 58% respectively, and an excess lung tissue of 701+/-321 ml was observed. The loss of gas was more pronounced in the lower than in the upper lobes. The lower lobes of 27% of the patients were characterized by "compression atelectasis," defined as a massive loss of aeration with no concomitant excess in lung tissue, and "inflammatory atelectasis," defined as a massive loss of aeration associated with an excess lung tissue, was observed in 73% of the patients. Three groups of patients were differentiated according to the appearance of their CT: 23% had diffuse attenuations evenly distributed in the two lungs, 36% had lobar attenuations predominating in the lower lobes, and 41% had patchy attenuations unevenly distributed in the two lungs. The three groups were similar regarding excess lung tissue in the upper and lower lobes and reduction in FRC in the lower lobes. In contrast, the FRC of the upper lobes was markedly lower in patients with diffuse or patchy attenuations than in healthy volunteers or patients with lobar attenuations.
These results demonstrate that striking differences in lung morphology, corresponding to different distributions of gas within the lungs, are observed in patients whose respiratory condition fulfills the definition criteria of ARDS.
比较急性呼吸窘迫综合征（ARDS）患者与健康志愿者肺部气体和组织分布的计算机断层扫描（CT）分析结果。
为期53个月的前瞻性研究。
一所大学医院的14张床位的外科重症监护病房。
71例连续的早期ARDS患者和11名健康志愿者。
对ARDS患者（呼气末正压为零时）和健康志愿者在呼气末进行肺部CT检查。ARDS患者的呼气末肺容积（气体+组织）和功能残气量（FRC）分别减少了17%和58%，并观察到701±321ml的多余肺组织。气体丢失在下叶比上叶更明显。27%的患者下叶表现为“压缩性肺不张”，定义为大量通气丧失且无伴随的肺组织过多，73%的患者观察到“炎症性肺不张”，定义为大量通气丧失并伴有肺组织过多。根据CT表现将患者分为三组：23%的患者两肺弥漫性衰减均匀分布，36%的患者叶性衰减以下叶为主，41%的患者斑片状衰减在两肺分布不均。三组在上叶和下叶的多余肺组织以及下叶FRC降低方面相似。相比之下，弥漫性或斑片状衰减患者上叶的FRC明显低于健康志愿者或叶性衰减患者。
这些结果表明，在呼吸状况符合ARDS定义标准的患者中，观察到肺部形态存在显著差异，这与肺内气体的不同分布相对应。
