基于影像学的ARDS诊疗进展:从形态到功能  

Advances on acute respiratory distress syndrome based on imaging:from morphology to function

作　　者：程卫[1] 何怀武[1] 苏龙翔[1] 崔娜[1] 王小亭[1] 周翔[1] 翁利[2] 隆云[1] 杜斌[2] 刘大为[1] CHENG Wei;HE HuaiWu;SU LongXiang;CUI Na;WANG XiaoTing;ZHOU Xiang;WENG Li;LONG Yun;DU Bin;LIU DaWei(Department of Critical Care Medicine,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Medical Critical Care Medicine,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院&北京协和医学院,北京协和医院,疑难重症及罕见病国家重点实验室,重症医学科,北京100730 [2]中国医学科学院&北京协和医学院,北京协和医院,疑难重症及罕见病国家重点实验室,内科ICU,北京100730

出　　处：《中国科学：生命科学》2021年第8期963-969,共7页Scientia Sinica(Vitae)

基　　金：北京市科技计划课题(首都临床诊疗技术研究及转化应用ARDS循环保护通气策略的建立和示范应用)(批准号:Z201100005520051);首都卫生发展科研专项(首发2020-2-40111);2020年北京临床重点专科卓越项目(批准号:ZK128001)资助。

摘　　要：急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)概念被提出的50年来,其争议和挑战不断.肺部影像学的进步见证了ARDS的发展变迁,从最早的胸部X线片到胸部断层扫描(computed tomography,CT),再到无放射性、床旁的胸部超声、电阻抗成像等方法,在ARDS的诊断和治疗以及对病理生理机制的研究中起到重要的作用.ARDS影像学发展从整体深入到局部,从肺通气深入到肺血流灌注,从单纯的呼吸评估到与循环评估相结合,从形态分析发展到功能评估.ARDS影像学不仅被应用于诊断,更侧重床旁连续评估以指导治疗.本文综述了目前临床可用的ARDS影像学评估进展,以期更好地理解ARDS的形态和功能改变,更好地指导临床治疗以改善患者预后.Controversy and challenges have accompanied acute respiratory distress syndrome(ARDS)since it was proposed 50 years ago.The progress of lung imaging has witnessed the development of ARDS.From the earliest chest X-ray to chest computed tomography(CT),to non-radioactive,bedside chest ultrasound,electrical impedance imaging and other methods,lung imaging plays an important role in the diagnosis and treatment of ARDS and the research of pathophysiological mechanism.The development of ARDS imaging progresses from whole to local,from pulmonary ventilation to blood perfusion,from simple respiratory assessment to combination with circulatory assessment,and from morphological analysis to functional assessment.Till now,ARDS imaging is not only used in diagnosis,but also in bedside continuous evaluation to guide treatment.This article systematically reviews the progress of clinically available imaging evaluation of ARDS,hoping to better understand the morphological and functional changes of ARDS,to guide clinical treatment,and to improve the prognosis of these patients.

关 键 词：急性呼吸窘迫综合征 胸部X线片 胸部断层扫描 肺部超声 胸部电阻抗断层成像 

分 类 号：R563.8[医药卫生—呼吸系统]