Lamy M, Fallat R J, Koeniger E, Dietrich H P, Ratliff J L, Eberhart R C, Tucker H J, Hill J D
Am Rev Respir Dis. 1976 Aug;114(2):267-84. doi: 10.1164/arrd.1976.114.2.267.
In 45 consecutive patients referred for severe hypoxemia (Pao2 less than 100 mm Hg on positive end-expiratory pressure of 5 cm H2O and fraction of inspired O2 of 1.0), physiologic studies of gas exchange were correlated with pathologic features from 36 open lung biopsies and 15 autopsies. Three distinct groups were defined. Group 1 included 11 patients with the most severe hypoxia (Pao2, 47 +/- 12 mm Hg), minimal Pao2 response to a 10 cm H2O increase in positive end-expiratory pressure (+2.0 +/- 4.0 mm Hg), and a fixed shunt at all fractions of inspired O2. Pathologic study showed edema, exudation, and hemorrhage to the point of consolidation. In group 2 were 13 patients who had less severe hypoxia (Pao2, 60 +/- 17 mm Hg) and a moderate Pao2 response to a 10 cm H2O increase in positive end-expiratory pressure (+15 +/- 8 mm Hg), but whose maximal response was slowly achieved (30 min to several hours). Pathologic examination showed extensive fibrosis. The 21 patients in group 3 had the least hypoxia (66 +/- 15 mm Hg), and had a rapid and marked improvement in Pao2 with a 10 cm H2O increase in positive end-expiratory pressure (+68 +/- 59 mm Hg). Pathologic features were similar to but less severe than those in group 1. Venous admixture increased with decreasing inspired concentrations of O2, indicating diffusion or ventilation-perfusion abnormalities in groups 2 and 3. Prognosis was best for group 3, with 10 of 21 long-term survivors. Two of 11 group 1 patients survived, but only after prolonged periods of extracorporeal membrane oxygenation. Despite biopsy evidence of extensive fibrosis, 3 of 13 in group 2 survived with moderate to good pulmonary function, including 1 survivor who had had extracorporeal membrane oxygenation. Such combined physiologic and pathologic studies are useful (1) for optimal respiratory care, (2) for prognosis, (3) for development of indications for extracorporeal membrane oxygenation, and (4) for better understanding of the pathophysiology of adult respiratory distress syndrome.
在45例因严重低氧血症（呼气末正压为5 cm H₂O、吸入氧分数为1.0时动脉血氧分压小于100 mmHg）而转诊的连续患者中，对气体交换进行了生理学研究，并与36例开胸肺活检及15例尸检的病理特征进行了关联分析。定义了三个不同的组。第1组包括11例低氧血症最严重的患者（动脉血氧分压为47±12 mmHg），呼气末正压增加10 cm H₂O时动脉血氧分压反应最小（增加2.0±4.0 mmHg），且在所有吸入氧分数下均存在固定分流。病理研究显示有水肿、渗出和出血至实变程度。第2组有13例患者，其低氧血症程度较轻（动脉血氧分压为60±17 mmHg），呼气末正压增加10 cm H₂O时动脉血氧分压有中度反应（增加15±8 mmHg），但其最大反应达到缓慢（30分钟至数小时）。病理检查显示广泛纤维化。第3组的21例患者低氧血症程度最轻（66±15 mmHg），呼气末正压增加10 cm H₂O时动脉血氧分压迅速且显著改善（增加68±59 mmHg）。病理特征与第1组相似但程度较轻。静脉混合随着吸入氧浓度降低而增加，表明第2组和第3组存在弥散或通气-灌注异常。第3组预后最佳，21例中有10例长期存活。第1组的11例患者中有2例存活，但仅在经过长时间体外膜肺氧合后存活。尽管活检有广泛纤维化的证据，但第2组的13例中有3例存活，肺功能为中度至良好，其中1例存活者曾接受体外膜肺氧合。这种生理学和病理学的联合研究对于（1）优化呼吸护理、（2）判断预后、（3）制定体外膜肺氧合的指征以及（4）更好地理解成人呼吸窘迫综合征的病理生理学是有用的。
