Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Compr Physiol. 2012 Oct;2(4):2471-80. doi: 10.1002/cphy.c100050.
Acute lung injury (ALI) and its most severe form, acute respiratory distress syndrome (ARDS), were presciently described nearly two centuries ago by René Laennec, later to be described clinically in the 1950s and 1960s. Substantial advances have been made in understanding the pathogenesis of these forms of permeability pulmonary edema, including Starling forces and cellular transport mechanisms involved in the generation and resolution of this form of lung injury. Functional animal models and clinically applicable case definitions for ALI and ARDS were instrumental in gaining these new insights. Although no specific pharmacological therapies for ALI and ARDS yet exist, outcomes have improved with advancements in respiratory and fluid-based supportive therapies, and methods to prevent the development or exacerbation of lung injury. Newer targeted therapies continue to be tested for efficacy in this condition where mortality rates frequently exceed 30%. In this article, we review the history of the pathophysiology of lung fluid and solute movement and the seminal clinical observations that brought that history to clinical relevance. We review the relevant lung structure and function and the dynamics of edema formation and resolution, and we describe the related clinical syndromes and the current treatment modalities.
急性肺损伤（ALI）及其最严重形式急性呼吸窘迫综合征（ARDS）在近两个世纪前就被 René Laennec 有先见之明地描述过，后来在 20 世纪 50 年代和 60 年代被临床描述。在理解这些通透性肺水肿形式的发病机制方面已经取得了重大进展，包括 Starling 力和细胞转运机制在这种肺损伤的产生和解决中所涉及的。功能性动物模型和可用于临床的 ALI 和 ARDS 病例定义在获得这些新的见解方面发挥了重要作用。尽管目前尚无针对 ALI 和 ARDS 的特定药物疗法，但随着呼吸和液体支持疗法的进步，以及预防肺损伤发展或恶化的方法，其预后已经得到改善。在这种死亡率经常超过 30%的情况下，新的靶向疗法继续在该病症的疗效测试中。在本文中，我们回顾了肺液和溶质运动的病理生理学历史以及将这一历史带入临床相关性的重要临床观察。我们回顾了相关的肺结构和功能以及水肿形成和消退的动力学，并描述了相关的临床综合征和当前的治疗方式。
