ALI/ARDS 肺動脈高壓的發病機制和治療策略_《中國呼吸與危重監護雜志》

作者：

潘純 , 邱海波

東南大學醫學院附屬中大醫院重癥醫學科東南大學急診與危重病研究所( 江蘇南京 210009);

關鍵詞：

急性肺損傷急性呼吸窘迫綜合征肺動脈高壓

視頻：

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ALI/ARDS 是常見的急性低氧性呼吸功能不全或衰竭的臨床綜合征, 而肺動脈高壓是ALI/ARDS 的基本特征之一, 其病理特征是肺血管的收縮、廣泛毛細血管的阻塞和閉
塞、肺動脈血管的重塑, 臨床表現主要為持續而難以糾正的低氧血癥和右心功能失代償, 與ALI/ARDS 患者肺損傷的嚴重程度相關, 是影響ALI/ARDS 患者預后的獨立危險因
素[ 1-4] , 因此, 了解肺動脈高壓的病因及發病機制對于防治ALI/ARDS肺動脈高壓具有重要意義。

引用本文： 潘純,邱海波. ALI/ARDS 肺動脈高壓的發病機制和治療策略. 中國呼吸與危重監護雜志, 2010, 9(5): 549-551. doi: 復制

1.	Bull TM, McFann K, Moss M, et al. Pulmonary hypertension is independently associated with poor outcome in patients with acute lung injury. Am J Respir Crit Care Med, 2009, 179: A5098.
2.	Zapol WM, Snider MT. Pulmonary hypertension in severe acute respiratory failure. N Engl J Med, 1977, 296 : 476 -480.
3.	Monchi M, Bellenfant F, Cariou A, et al. Early predictive factors of survival in the acute respiratory distress syndrome. AmJ Respir Crit Care Med, 1998, 158 : 1076-1081.
4.	Jardin F, Vieillard-Baron A. Is there a safe plateau pressure in ARDS? The right heart only knows. Intensive Care Med, 2007, 33 :444 -447.
5.	Schuster DP. ARDS: clinical lessons from the oleic acid model of acute lung injury. Am JRespir Crit Care Med, 1994, 149 : 245-260 .
6.	Moloney ED, Evans TW. Pathophysiology and pharmacological treatment of pulmonary hypertension in acute respiratory distress syndrome. Eur Respir J, 2003, 21: 720-727 .
7.	Nunes S, Ruokonen E, Takala J. Pulmonary capillary pressures during the acute respiratory distress syndrome. Intensive Care Med,2003, 29: 2174 -2179 .
8.	Grasso S, Stripoli T, Sacchi M, et al. Inhomogeneity of lung parenchyma during the open lung strategy. Am J Respir Crit Care Med, 2009, 180 : 415 -423.
9.	Tomashefski JF, Davies P, Boggis C, et al. The pulmonary vascular lesions of the adult respiratory distress syndrome. Am J Pathol,1983, 112 : 112 -126.
10.	Bellingan GJ. The pulmonary physician in critical care: The pathogenesis of ALI/ARDS. Thorax, 2002, 57: 540-546.
11.	El-Haroun H, Clarke DL, Deacon K, et al. IL-1 β, BK, and TGF-β1 attenuate PGI2 -mediated cAMP formation in human pulmonary artery smooth muscle cells by multiple mechanisms involving p38 MAP kinase and PKA. Am J Physiol Lung Cell Mol Physiol, 2008 ,294: L553-L562.
12.	Witzenrath M, Gutbier B, Owen JS, et al. Role of platelet-activating factor in pneumolysin-induced acute lung injury. Crit Care Med,2007, 35: 1756 -1762.
13.	Sanchez O, Marcos E, Perros F, et al. Role of endothelium-derived CC chemokine ligand 2 in idiopathic pulmonary arterial hypertension. Am J Respir Crit Care Med, 2007, 176: 1041-1047.
14.	Adamzik M, Frey U, Sixt S, et al. ACE I/D but not AGT( -6 ) A/ G polymorphism is a risk factor for mortality in ARDS. Eur Respir J,2007, 29: 482-488.
15.	Yamazato Y, Ferreira AJ, Hong K, et al. Prevention of pulmonary hypertension by angiotensin-converting enzyme 2 gene transfer.Hypertension, 2009, 54 : 365-371.
16.	Terragni PP, Rosboch G, Tealdi A, et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome.Am J Respir Crit Care Med, 2007, 175: 160-166.
17.	Mentzelopoulos SD, Roussos C, Zakynthinos SG, et al. Prone position reduces lung stress and strain in severe acute respiratory distress syndrome. Eur Respir J, 2005, 25: 534-544 .
18.	Baron AV, Charron C, Caille V, et al. Prone Positioning Unloads the Right Ventricle in Severe ARDS. Chest, 2007 , 132: 1440 -1446 .
19.	Hsu C, Lee DL, Lin S, et al. The initial response to inhaled nitric oxide treatment for intensive care unit patients with acute respiratory distress syndrome. Respiration, 2008, 75: 288-295.
20.	Adhikari NK, Burns KE, Friedrich JO, et al. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ, 2007, 334: 779-787.
21.	Cepkova M, Matthay MA. Pharmacotherapy of acute lung injury and the acute respiratory distress syndrome. J Intensive Care Med, 2006 ,21: 119-143.
22.	ZamanianRT, Haddad F, Doyle RL, et al. Management strategies for patients with pulmonary hypertension in the intensive care unit. Crit Care Med, 2007, 35: 2037 -2050 .
23.	Cornet AD, Hofstra JJ, Swart EL, et al. Sildenafil attenuates pulmonary arterial pressure, but does not improve oxygenation during ARDS. Intensive Care Med, 2010, 36: 758 -764.
24.	Fesler P, Pagnamenta A, Rondelet B, et al. Effects of sildenafil on hypoxic pulmonary vascular function in dogs. J Appl Physiol, 2006 ,101: 1085-1090.
25.	Laterre PF, Wittebole X, Dhainaut JF. Anticoagulant therapy in acute lung injury. Crit Care Med, 2003 , 31 : S329-S336 .

1. Bull TM, McFann K, Moss M, et al. Pulmonary hypertension is independently associated with poor outcome in patients with acute lung injury. Am J Respir Crit Care Med, 2009, 179: A5098.
2. Zapol WM, Snider MT. Pulmonary hypertension in severe acute respiratory failure. N Engl J Med, 1977, 296 : 476 -480.
3. Monchi M, Bellenfant F, Cariou A, et al. Early predictive factors of survival in the acute respiratory distress syndrome. AmJ Respir Crit Care Med, 1998, 158 : 1076-1081.
4. Jardin F, Vieillard-Baron A. Is there a safe plateau pressure in ARDS? The right heart only knows. Intensive Care Med, 2007, 33 :444 -447.
5. Schuster DP. ARDS: clinical lessons from the oleic acid model of acute lung injury. Am JRespir Crit Care Med, 1994, 149 : 245-260 .
6. Moloney ED, Evans TW. Pathophysiology and pharmacological treatment of pulmonary hypertension in acute respiratory distress syndrome. Eur Respir J, 2003, 21: 720-727 .
7. Nunes S, Ruokonen E, Takala J. Pulmonary capillary pressures during the acute respiratory distress syndrome. Intensive Care Med,2003, 29: 2174 -2179 .
8. Grasso S, Stripoli T, Sacchi M, et al. Inhomogeneity of lung parenchyma during the open lung strategy. Am J Respir Crit Care Med, 2009, 180 : 415 -423.
9. Tomashefski JF, Davies P, Boggis C, et al. The pulmonary vascular lesions of the adult respiratory distress syndrome. Am J Pathol,1983, 112 : 112 -126.
10. Bellingan GJ. The pulmonary physician in critical care: The pathogenesis of ALI/ARDS. Thorax, 2002, 57: 540-546.
11. El-Haroun H, Clarke DL, Deacon K, et al. IL-1 β, BK, and TGF-β1 attenuate PGI2 -mediated cAMP formation in human pulmonary artery smooth muscle cells by multiple mechanisms involving p38 MAP kinase and PKA. Am J Physiol Lung Cell Mol Physiol, 2008 ,294: L553-L562.
12. Witzenrath M, Gutbier B, Owen JS, et al. Role of platelet-activating factor in pneumolysin-induced acute lung injury. Crit Care Med,2007, 35: 1756 -1762.
13. Sanchez O, Marcos E, Perros F, et al. Role of endothelium-derived CC chemokine ligand 2 in idiopathic pulmonary arterial hypertension. Am J Respir Crit Care Med, 2007, 176: 1041-1047.
14. Adamzik M, Frey U, Sixt S, et al. ACE I/D but not AGT( -6 ) A/ G polymorphism is a risk factor for mortality in ARDS. Eur Respir J,2007, 29: 482-488.
15. Yamazato Y, Ferreira AJ, Hong K, et al. Prevention of pulmonary hypertension by angiotensin-converting enzyme 2 gene transfer.Hypertension, 2009, 54 : 365-371.
16. Terragni PP, Rosboch G, Tealdi A, et al. Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome.Am J Respir Crit Care Med, 2007, 175: 160-166.
17. Mentzelopoulos SD, Roussos C, Zakynthinos SG, et al. Prone position reduces lung stress and strain in severe acute respiratory distress syndrome. Eur Respir J, 2005, 25: 534-544 .
18. Baron AV, Charron C, Caille V, et al. Prone Positioning Unloads the Right Ventricle in Severe ARDS. Chest, 2007 , 132: 1440 -1446 .
19. Hsu C, Lee DL, Lin S, et al. The initial response to inhaled nitric oxide treatment for intensive care unit patients with acute respiratory distress syndrome. Respiration, 2008, 75: 288-295.
20. Adhikari NK, Burns KE, Friedrich JO, et al. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ, 2007, 334: 779-787.
21. Cepkova M, Matthay MA. Pharmacotherapy of acute lung injury and the acute respiratory distress syndrome. J Intensive Care Med, 2006 ,21: 119-143.
22. ZamanianRT, Haddad F, Doyle RL, et al. Management strategies for patients with pulmonary hypertension in the intensive care unit. Crit Care Med, 2007, 35: 2037 -2050 .
23. Cornet AD, Hofstra JJ, Swart EL, et al. Sildenafil attenuates pulmonary arterial pressure, but does not improve oxygenation during ARDS. Intensive Care Med, 2010, 36: 758 -764.
24. Fesler P, Pagnamenta A, Rondelet B, et al. Effects of sildenafil on hypoxic pulmonary vascular function in dogs. J Appl Physiol, 2006 ,101: 1085-1090.
25. Laterre PF, Wittebole X, Dhainaut JF. Anticoagulant therapy in acute lung injury. Crit Care Med, 2003 , 31 : S329-S336 .

《中國呼吸與危重監護雜志》

ALI/ARDS 肺動脈高壓的發病機制和治療策略

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《中國呼吸與危重監護雜志》

ALI/ARDS 肺動脈高壓的發病機制和治療策略

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