[내과] ARDS

등록일 2002.08.02 한글 (hwp) | 4페이지 | 가격 300원

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CLINICAL, PATHOLOGICAL, AND RADIOGRAPHIC FEATURES
-arterial hypoxemia that is refractory to treatment with supplemental oxygen is characteristic
-radiologic findings are indistinguishable from those of cardiogenic pulmonary edema
-bilateral infiltrates may be patchy or asymmetric and may include pleural effusions
-in CTscanning: alveolar filling, consolidation, and atelectasis occur in dependent lung zone
-in BAL studies: nondependent areas may have substantial inflammation
-pathological findings include diffuse alveolar damage, with neutrophils, macrophages, erythrocytes, hyaline membranes, and protein rich edema fluid in the alveolar spaces, capillary injury, and disruption of the alveolar epithelium.
-Although acute lung infury and the acute respiratory distress syndrome may resolve completely in some patients after the acute phase, in others it progresses to fibrosing alveolitis with persistent hypoxemia, increased alveolar dead space, and a further decrease in pulmonary compliance. Pulmonary hypertension, owing to obliteration of the pulmonary capillary bed, may be severe and may lead to right ventricular failure. Chest radiographs show linear opacities, consistent with the presence of evolving fibrosis. Pneumothorax may occre, but the incidence is only 10 to 13 percent and is not clearly related to airway pressures of the level of positive end-expiratory pressure. Computed tomography of the chest shows diffuse interstitial opacities and bullae. Histologically, there is fibrosis along with acute and chronic inflammatory cells and partial resolution of the pulmonary edema. The recovery phase is characterized by the gradual resolution of hypoxemia and improved lung compliance. Typically, the radiographic abnormalities resolve completely. The degree of histologic resolution of fibrosis has not been well characterized, although in many patients pulmonary function returns to normal.
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