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1、急性呼吸窘迫綜合征NEnglJMed2003;348:683-693.NEnglJMed2003;348:683-693.NEnglJMed2003;348:683-693.MethodsWeevaluated109survivorsoftheacuterespiratorydistresssyndrome3,6,and12monthsafterdischargefromtheintensivecareunit.Ateachvisit,patientswereinterviewedandunderwentaphysicalexaminat
2、ion,pulmonary-functiontesting,asix-minute–walktest,andaquality-of-lifeevaluation.ResultsPatientswhosurvivedtheacuterespiratorydistresssyndromewereyoung(medianage,45years)andseverelyill(medianAcutePhysiology,Age,andChronicHealthEvaluationscore,23)andhadalongstayintheintens
3、ivecareunit(median,25days).Patientshadlost18percentoftheirbase-linebodyweightbythetimetheyweredischargedfromtheintensivecareunitandstatedthatmuscleweaknessandfatiguewerethereasonsfortheirfunctionallimitation.Lungvolumeandspirometricmeasurementswerenormalby6months,butcarbo
4、nmonoxidediffusioncapacityremainedlowthroughoutthe12-monthfollow-up.Nopatientsrequiredsupplementaloxygenat12months,but6percentofpatientshadarterialoxygensaturationvaluesbelow88percentduringexercise.ThemedianscoreforthephysicalroledomainoftheMedicalOutcomesStudy36-itemShor
5、t-FormGeneralHealthSurvey(ahealth-relatedquality-of-lifemeasure)increasedfrom0at3monthsto25at12months(scoreinthenormalpopulation,84).Thedistancewalkedinsixminutesincreasedfromamedianof281mat3monthsto422mat12months;allvalueswerelowerthanpredicted.Theabsenceofsystemiccortic
6、osteroidtreatment,theabsenceofillnessacquiredduringtheintensivecareunitstay,andrapidresolutionoflunginjuryandmultiorgandysfunctionwereassociatedwithbetterfunctionalstatusduringtheone-yearfollow-up.ConclusionsSurvivorsoftheacuterespiratorydistresssyndromehavepersistentfunc
7、tionaldisabilityoneyearafterdischargefromtheintensivecareunit.Mostpatientshaveextrapulmonaryconditions,withmusclewastingandweaknessbeingmostprominent.NEnglJMed2003;348:683-693.定義ALI/ARDS是指由心源性以外的各種肺內(nèi)外致病因素導(dǎo)致的急性、進(jìn)行性缺氧性呼吸衰竭。ALI/ARDS具有性質(zhì)相同的病理生理改變，嚴(yán)重的ALI即被定義為ARDS。ALI/ARDS以肺微血管
8、通透性增加、肺氣容積減少、肺順應(yīng)性降低和嚴(yán)重肺內(nèi)分流及通氣/血流比例失調(diào)為病理生理特點(diǎn)，臨床表現(xiàn)為不易緩解的急性進(jìn)行性缺氧性呼吸衰竭，胸部X線可見(jiàn)肺部浸潤(rùn)征象。高危因素一、直接肺損傷因素嚴(yán)重肺
