Vesconi S, Rossi G P, Pesenti A, Fumagalli R, Gattinoni L
Department of Anesthesiology, Ospedale Maggiore, Milan, Italy.
Crit Care Med. 1988 Feb;16(2):111-3. doi: 10.1097/00003246-198802000-00002.
Pulmonary microvascular occlusive disease has been investigated using balloon occlusive pulmonary angiography in 31 patients with severe adult respiratory distress syndrome (ARDS) of different origins (14 patients with pneumonia, nine with multiple injury, eight with sepsis). Multiple pulmonary artery filling defects (PAFD) were detected in 13 (42%) patients, with a seven (78%) in nine incidence among those with posttraumatic ARDS. The presence of PAFD did not correlate with the severity of the respiratory failure, with the pulmonary hemodynamic alterations (pulmonary hypertension and increased vascular resistance), or with the final outcome (mortality rate was 54% among patients with PAFD and 61% among those with normal angiograms). These findings suggest that widespread pulmonary microthrombosis is a common event in patients with polytrauma and respiratory failure, with an important pathophysiologic role in the onset of posttraumatic ARDS.
采用球囊闭塞性肺血管造影术对31例不同病因的重度成人呼吸窘迫综合征（ARDS）患者（14例肺炎患者、9例多发伤患者、8例脓毒症患者）进行了肺微血管闭塞性疾病的研究。13例（42%）患者检测到多发性肺动脉充盈缺损（PAFD），其中创伤后ARDS患者中9例有7例（78%）出现PAFD。PAFD的存在与呼吸衰竭的严重程度、肺血流动力学改变（肺动脉高压和血管阻力增加）或最终结局均无相关性（有PAFD患者的死亡率为54%，血管造影正常患者的死亡率为61%）。这些发现提示，广泛的肺微血栓形成在多发伤和呼吸衰竭患者中是常见事件，在创伤后ARDS的发病中具有重要的病理生理作用。
