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儿童肺不张

Author
Jonathan D Finder, MD
Section Editor
Gregory Redding, MD
Deputy Editor
Alison G Hoppin, MD
Translators
杨玉林, 主任医师

引言

肺不张(atelectasis)一词来源于希腊语，意为缺乏伸展；医学应用中，该术语是指肺容积的缩小或萎陷。肺不张也定义为肺泡腔萎陷，其程度通常严重到足以产生胸片表现。肺不张是儿科患者的一种常见问题。现已观察到儿童肺不张的3种主要类型，包括阻塞性肺不张、吸收性肺不张和压迫性肺不张。在几乎所有病例中，肺不张是获得性的，称为继发性；极少数情况下，先天性异常引起的原发性肺不张可能从出生就存在。儿童肺不张的概述见此专题。肺不张的放射影像学表现和成人肺不张的概述见其他专题。 (参见“肺叶肺不张的影像学表现”和“肺不张：成人肺不张的类型和发病机制”)

病理生理学

为了认识肺不张的病理生理学，有必要总结防止肺萎陷的正常机制。肺泡壁内的弹性纤维使肺泡趋于向内回缩。这种效应通过胸壁向外的回弹以及壁胸膜与脏胸膜之间的相互作用而得到平衡。此外，保持肺在低容积时不发生萎陷的主要机制是表面活性物质。

表面活性物质是由Ⅱ型肺泡上皮细胞产生的一种复杂的磷脂和蛋白混合物。其作用是降低表面张力，由拉普拉斯定律定义为：

压力=2×表面张力/半径

肺泡容量随着呼气而降低时，表面张力增加到相应程度，这种程度下如果没有表面活性物质，肺泡将完全萎陷。对于可使表面活性物质的产生或者稳态丧失或减弱的疾病，包括新生儿呼吸窘迫综合征、先天性表面活性物质蛋白B缺乏症和肺泡蛋白沉积症，这种粘连性肺不张将具有临床意义。 (参见“新生儿呼吸窘迫概述：过渡期疾病”和“成人肺泡蛋白沉积症的临床表现和病因”)

                     

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Literature review current through: 2017-07 . | This topic last updated: 2016-06-15.
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