Tomashefski J F, Davies P, Boggis C, Greene R, Zapol W M, Reid L M
Am J Pathol. 1983 Jul;112(1):112-26.
Specimen arteriography, morphometry, and light and electron microscopy were used for examination of the pulmonary vasculature of 22 patients who died with the adult respiratory distress syndrome (ARDS), for the purpose of defining the lesions that contribute to pulmonary hypertension in this setting. The different lesions correlated with the duration rather than the cause of ARDS. Thromboemboli occurred in 21 patients, and macrothrombi found at autopsy correlated with the number of filling defects on antemortem angiography. Acute endothelial injury was documented ultrastructurally even in intermediate and late-stage patients. Fibrocellular intimal obliteration of arteries, veins, and lymphatics and infective vasculitis were prominent in those surviving beyond 10 days. In long-term survivors, tortuous arteries and irregularly dilated capillaries were striking features. Peripheral extension of vascular smooth muscle and a significant increase in the percentage of medial thickness of muscular arteries with duration of ARDS were noted. The pathogenesis and clinical significance of these lesions is discussed.
采用标本动脉造影、形态测量以及光镜和电镜检查，对22例死于成人呼吸窘迫综合征（ARDS）患者的肺血管系统进行检查，目的是明确在此情况下导致肺动脉高压的病变。不同病变与ARDS的病程而非病因相关。21例患者出现血栓栓塞，尸检发现的大血栓与生前血管造影的充盈缺损数量相关。即使在中期和晚期患者中，超微结构也证实存在急性内皮损伤。动脉、静脉和淋巴管的纤维细胞内膜闭塞以及感染性血管炎在存活超过10天的患者中较为突出。在长期存活者中，动脉迂曲和毛细血管不规则扩张是显著特征。注意到随着ARDS病程的延长，血管平滑肌向周边延伸以及肌性动脉中膜厚度百分比显著增加。讨论了这些病变的发病机制和临床意义。
