Fort Belvoir Community Hospital Family Medicine Residency, Fort Belvoir, VA, USA.
Am Fam Physician. 2012 Feb 15;85(4):352-8.
Acute respiratory distress syndrome manifests as rapidly progressive dyspnea, tachypnea, and hypoxemia. Diagnostic criteria include acute onset, profound hypoxemia, bilateral pulmonary infiltrates, and the absence of left atrial hypertension. Acute respiratory distress syndrome is believed to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators, promoting neutrophil accumulation in the microcirculation of the lung. Neutrophils damage the vascular endothelium and alveolar epithelium, leading to pulmonary edema, hyaline membrane formation, decreased lung compliance, and difficult air exchange. Most cases of acute respiratory distress syndrome are associated with pneumonia or sepsis. It is estimated that 7.1 percent of all patients admitted to an intensive care unit and 16.1 percent of all patients on mechanical ventilation develop acute lung injury or acute respiratory distress syndrome. In-hospital mortality related to these conditions is between 34 and 55 percent, and most deaths are due to multiorgan failure. Acute respiratory distress syndrome often has to be differentiated from congestive heart failure, which usually has signs of fluid overload, and from pneumonia. Treatment of acute respiratory distress syndrome is supportive and includes mechanical ventilation, prophylaxis for stress ulcers and venous thromboembolism, nutritional support, and treatment of the underlying injury. Low tidal volume, high positive end-expiratory pressure, and conservative fluid therapy may improve outcomes. A spontaneous breathing trial is indicated as the patient improves and the underlying illness resolves. Patients who survive acute respiratory distress syndrome are at risk of diminished functional capacity, mental illness, and decreased quality of life; ongoing care by a primary care physician is beneficial for these patients.
急性呼吸窘迫综合征的表现为迅速进展的呼吸困难、呼吸急促和低氧血症。诊断标准包括急性发作、严重低氧血症、双侧肺部浸润和不存在左心房高压。急性呼吸窘迫综合征被认为是在肺或肺外损伤导致炎症介质释放时发生的，这些介质促进中性粒细胞在肺部微循环中的积聚。中性粒细胞会损伤血管内皮和肺泡上皮，导致肺水肿、透明膜形成、肺顺应性降低和空气交换困难。大多数急性呼吸窘迫综合征与肺炎或败血症有关。据估计，入住重症监护病房的所有患者中有 7.1%和接受机械通气的所有患者中有 16.1%会发生急性肺损伤或急性呼吸窘迫综合征。与这些情况相关的住院死亡率在 34%至 55%之间，大多数死亡是由于多器官衰竭。急性呼吸窘迫综合征通常需要与充血性心力衰竭相区分，后者通常有液体超负荷的迹象，还需要与肺炎相区分。急性呼吸窘迫综合征的治疗是支持性的，包括机械通气、预防应激性溃疡和静脉血栓栓塞、营养支持以及治疗基础损伤。小潮气量、高呼气末正压和保守液体疗法可能会改善结果。当患者病情改善且基础疾病得到解决时，应进行自主呼吸试验。存活的急性呼吸窘迫综合征患者有功能能力下降、精神疾病和生活质量降低的风险；初级保健医生的持续护理对这些患者有益。
