Novikova R I, Shano V P, Nesterenko A N, Dzhodzhua T V, Latartseva L N, Tiumentseva S G
Anesteziol Reanimatol. 1993 Mar-Apr(2):28-32.
Clinical and morphologic studies were carried out in 230 patients suffering a grave course of an exacerbation of infectious bronchial asthma. A protracted attack of the condition was detected in 70 patients, in 80 patients status asthmaticus, Stages I-II was found, 50 patients suffered a Stage III status asthmaticus, and 30 patients were hospitalized in the terminal state and died within 12 hours since admission. The circulatory, metabolic, immunologic homeostasis parameters were studied, morphologic, examination of pulmonary, tracheal, cardiac, cerebral, splenic and hepatic tissue was carried out in 30 patients who died at the height of the status asthmaticus. The authors have analyzed the contribution of the homeostasis parameters to the formation of the critical state in status asthmaticus and the relationships of these parameters between each other and with the condition severity. The severity of the patients' condition was found closely related to the degree of respiratory, circulatory, and metabolic disturbances. Respiratory failure and circulatory disorders were the principal clinical manifestations of status asthmaticus, though the disorders of the metabolic and immunologic homeostasis also much contributed to the formation of a critical condition due to status asthmaticus. Characteristic histomorphologic changes of the viscera, detected at autopsy, were the morphologic equivalent of these clinical symptoms. The findings regarding status asthmaticus as a critical state that is characterized by the development of multiorgan insufficiency involving the formation of incompetence of natural detoxication routes.
对230例患有严重加重期感染性支气管哮喘的患者进行了临床和形态学研究。发现70例患者病情呈持续性发作,80例为哮喘持续状态Ⅰ - Ⅱ期,50例为哮喘持续状态Ⅲ期,30例患者处于终末期入院并在入院后12小时内死亡。研究了循环、代谢、免疫稳态参数,对30例在哮喘持续状态高峰期死亡的患者进行了肺、气管、心脏、脑、脾和肝组织的形态学检查。作者分析了稳态参数对哮喘持续状态临界状态形成的作用,以及这些参数之间的相互关系及其与病情严重程度的关系。发现患者病情的严重程度与呼吸、循环和代谢紊乱的程度密切相关。呼吸衰竭和循环障碍是哮喘持续状态的主要临床表现,尽管代谢和免疫稳态紊乱也对哮喘持续状态导致的临界状态形成有很大影响。尸检时发现的内脏特征性组织形态学变化是这些临床症状的形态学对应表现。关于哮喘持续状态作为一种临界状态的研究结果表明,其特征是多器官功能不全的发展,包括自然解毒途径功能障碍的形成。