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

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(xiàn)主要為持續(xù)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(fā)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(fā)病機制和治療策略. 中國呼吸與危重監(jiān)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. 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. 2. Zapol WM, Snider MT. Pulmonary hypertension in severe acute respiratory failure. N Engl J Med, 1977, 296 : 476 -480.
  3. 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. 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. 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. 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. 7. Nunes S, Ruokonen E, Takala J. Pulmonary capillary pressures during the acute respiratory distress syndrome. Intensive Care Med,2003, 29: 2174 -2179 .
  8. 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. 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. 10. Bellingan GJ. The pulmonary physician in critical care: The pathogenesis of ALI/ARDS. Thorax, 2002, 57: 540-546.
  11. 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. 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. 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. 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. 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. 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. 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. 18. Baron AV, Charron C, Caille V, et al. Prone Positioning Unloads the Right Ventricle in Severe ARDS. Chest, 2007 , 132: 1440 -1446 .
  19. 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. 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. 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. 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. 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. 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. 25. Laterre PF, Wittebole X, Dhainaut JF. Anticoagulant therapy in acute lung injury. Crit Care Med, 2003 , 31 : S329-S336 .