Maunder R J, Shuman W P, McHugh J W, Marglin S I, Butler J
JAMA. 1986 May 9;255(18):2463-5.
In this report, we challenge the commonly held assumption that the adult respiratory distress syndrome (ARDS) is a homogeneous process associated with generalized and relatively uniform damage to the alveolar capillary membrane. We studied 13 patients with ARDS, comparing the pulmonary parenchymal changes seen by standard bedside chest roentgenograms with those seen by computed tomography of the chest. Three patients demonstrated generalized lung involvement by both radiologic techniques. In another eight patients, despite the appearance of generalized involvement on the standard chest x-ray film, the computed tomographic scans showed patchy infiltrates interspersed with areas of normal-appearing lung. Two patients showed patchy involvement by both techniques. The fact that ARDS spares some regions of lung parenchyma is useful knowledge in understanding the gas-exchange abnormalities of ARDS, the variable responsiveness to positive end-expiratory pressure, and the occurrence of oxygen toxicity. The problem of regional inhomogeneity should also be kept in mind when interpreting lung biopsy specimens or bronchoalveolar lavage fluid in patients with ARDS.
在本报告中，我们对一种普遍持有的假设提出质疑，即成人呼吸窘迫综合征（ARDS）是一个均质化过程，与肺泡毛细血管膜的广泛性和相对均匀性损伤相关。我们研究了13例ARDS患者，将标准床边胸部X线片所见的肺实质改变与胸部计算机断层扫描所见的进行比较。通过两种放射学技术，有3例患者显示肺部广泛受累。在另外8例患者中，尽管标准胸部X线片显示肺部广泛受累，但计算机断层扫描显示有散在的斑片状浸润，其间夹杂着外观正常的肺组织区域。有2例患者通过两种技术均显示有斑片状受累。ARDS不累及某些肺实质区域这一事实，对于理解ARDS的气体交换异常、对呼气末正压的不同反应以及氧中毒的发生很有帮助。在解读ARDS患者的肺活检标本或支气管肺泡灌洗液时，也应牢记区域不均一性问题。
