Garbella Erika, Catapano Giosuè, Pratali Lorenza, Pingitore Alessandro
Clinical Physiology Institute, CNR, Via Moruzzi 1, 56124 Pisa, Italy.
Pulm Med. 2011;2011:275857. doi: 10.1155/2011/275857. Epub 2011 Jun 22.
There are several pieces of evidence showing occurrence of pulmonary edema (PE) in healthy subjects in extreme conditions consisting of extreme psychophysical demand in normal environment and psychophysical performances in extreme environment. A combination of different mechanisms, such as mechanical, hemodynamic, biochemical, and hypoxemic ones, may underlie PE leading to an increase in lung vascular hydrostatic pressure and lung vascular permeability and/or a downregulation of the alveolar fluid reabsorption pathways. PE can be functionally detected by closing volume measurement and lung diffusing capacity test to different gases or directly visualized by multiple imaging techniques. Among them chest ultrasonography can detect and quantify the extravascular lung water, creating "comet-tail" ultrasound artefacts (ULCs) from water-thickened pulmonary interlobular septa. In this paper the physiopathological mechanisms of PE, the functional and imaging techniques applied to detect and quantify the phenomenon, and three models of extreme conditions, that is, ironman athletes, climbers and breath-hold divers, are described.
有多项证据表明，在极端条件下，健康受试者会出现肺水肿（PE），这些极端条件包括正常环境下的极端心理生理需求以及极端环境下的心理生理表现。多种不同机制的组合，如机械、血流动力学、生化和低氧机制，可能是导致肺水肿的基础，进而导致肺血管静水压和肺血管通透性增加和/或肺泡液体重吸收途径下调。肺水肿可以通过闭合气量测量和对不同气体的肺弥散能力测试进行功能检测，或者通过多种成像技术直接观察到。其中，胸部超声检查可以检测和量化血管外肺水，从增厚的肺小叶间隔中产生“彗尾”超声伪像（ULC）。本文描述了肺水肿的生理病理机制、用于检测和量化该现象的功能和成像技术，以及三种极端条件模型，即铁人三项运动员、登山者和屏气潜水员。
