首页 期刊 论文 学科刊群 资讯 加盟 关于
EN
image
Article(id=1208106714071666825, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208106710208717234, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2022.04.0321, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1626105600000, receivedDateStr=2021-07-13, revisedDate=null, revisedDateStr=null, acceptedDate=1643299200000, acceptedDateStr=2022-01-28, onlineDate=1765964686172, onlineDateStr=2025-12-17, pubDate=1651075200000, pubDateStr=2022-04-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1765964686172, onlineIssueDateStr=2025-12-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1765964686172, creator=13701087609, updateTime=1765964686172, updator=13701087609, issue=Issue{id=1208106710208717234, tenantId=1146029695717560320, journalId=1189873630562394117, year='2022', volume='47', issue='4', pageStart='321', pageEnd='426', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1765964685250, creator=13701087609, updateTime=1765964685250, updator=13701087609, preIssue=null, nextIssue=null, ext=null, issueFiles=null}, startPage=321, endPage=325, ext={EN=ArticleExt(id=1208106714365268124, articleId=1208106714071666825, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Acute respiratory distress syndrome following chronic hypoxic exposure: more attention should be paid to right ventricular function at high altitude, columnId=1190669170040783872, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Expert Review, runingTitle=null, highlight=null, articleAbstract=

During acute respiratory distress syndrome (ARDS) occurs, the pulmonary vasoconstriction increased pulmonary vascular resistance, led to pulmonary arterial hypertension and excessive right ventricular afterload, followed by acute corpulmonale(ACP), aggravated right ventricular function damage, bring about pulmonary edema and hypoxemia, those are the important causes lead to patient death. Healthy people exposed to chronic hypoxia at high altitude for a long period prone to physiological pulmonary hypertension and change of blood viscosity, thus aggravating the severity of ARDS at high altitude. Therefore, the pathophysiological changes of ARDS are different in plateau to that in plain areas, and the diagnostic criteria, clinical manifestations and severity of the disease are also different. In present paper, the factors affecting the aggravation of right heart damage were discussed from a pathophysiological point, and a proposal was made that monitoring and protection of right ventricular function should be paid more attention in plateau and hypoxia environment for ARDS patient, optimizing respiratory support therapy, pulmonary vasodilation therapy and anticoagulant therapy for reducing the iatrogenic injury in treatment and improving the survival rate of ARDS patients.

, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Si-Qing Ma), CN=ArticleExt(id=1208106714654675121, articleId=1208106714071666825, tenantId=1146029695717560320, journalId=1189873630562394117, language=CN, title=高原慢性低氧暴露下的急性呼吸窘迫综合征：更应关注右心功能, columnId=1190669170267275266, journalTitle=解放军医学杂志, columnName=专家述评, runingTitle=null, highlight=null, articleAbstract=

急性呼吸窘迫综合征(ARDS)时肺血管收缩、肺血管阻力增加、肺动脉高压，导致患者右心后负荷过高，继而并发急性肺心病(ACP)，加重右心功能损害，出现严重肺水肿及低氧血症。长期暴露在高原慢性低氧环境的健康人，极易出现生理性肺动脉高压及血液黏滞度改变等，这些因素会加重高原ARDS的严重程度。因此，高原ARDS与平原ARDS的病理生理变化有所不同，诊断标准、临床表现、病情严重程度也不一致。本文从高原ARDS的病理生理机制出发，探讨右心功能损害的影响因素，提出高原慢性低氧暴露下的ARDS更应关注右心功能的监测与保护，优化呼吸支持治疗、肺血管扩张治疗、抗凝治疗等，以减少治疗中的再损伤，提高ARDS救治的存活率。

, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=q6G0L3lhNn5JwPXVbhUS9Q==, magXml=erbYQxlER5ock7aWpu8JZg==, pdfUrl=null, pdf=yRM8u/h25BEaHM4zvn5exQ==, pdfFileSize=921392, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=bnjQUCY98Hbwp8m23vfm4w==, mapNumber=null, authorCompany=null, fund=null, authors=

马四清，主任医师，中华医学会高原医学分会常委、危重病学组组长，青海省重症医学分会主任委员，国家卫生计生突出贡献中青年专家，青海省“昆仑英才·高端创新创业人才”杰出人才。

, authorsList=马四清)}, authors=[Author(id=1208106714994413769, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1208106715090882766, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, authorId=1208106714994413769, language=EN, stringName=Si-Qing Ma, firstName=Si-Qing, middleName=null, lastName=Ma, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Department of Critical Care Medicine, Qinghai Provincial People's Hospital, Xining 810007, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1208106715157991634, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, authorId=1208106714994413769, language=CN, stringName=马四清, firstName=四清, middleName=null, lastName=马, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=青海省人民医院重症医学科，西宁 810007, bio={"content":"

马四清，主任医师，中华医学会高原医学分会常委、危重病学组组长，青海省重症医学分会主任委员，国家卫生计生突出贡献中青年专家，青海省“昆仑英才·高端创新创业人才”杰出人才。

"}, bioImg=null, bioContent=

马四清，主任医师，中华医学会高原医学分会常委、危重病学组组长，青海省重症医学分会主任委员，国家卫生计生突出贡献中青年专家，青海省“昆仑英才·高端创新创业人才”杰出人才。

, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1208106714906333377, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, xref=null, ext=[AuthorCompanyExt(id=1208106714914721986, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, companyId=1208106714906333377, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Critical Care Medicine, Qinghai Provincial People's Hospital, Xining 810007, China), AuthorCompanyExt(id=1208106714918916292, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, companyId=1208106714906333377, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=青海省人民医院重症医学科，西宁 810007)])])], keywords=[Keyword(id=1208106715279626460, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, language=EN, orderNo=1, keyword=respiratory distress syndrome, adult), Keyword(id=1208106715346735326, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, language=EN, orderNo=2, keyword=hypoxia), Keyword(id=1208106715447398627, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, language=EN, orderNo=3, keyword=corpulmonale), Keyword(id=1208106715543867622, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, language=EN, orderNo=4, keyword=ventricular function, right), Keyword(id=1208106715640336618, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, language=CN, orderNo=1, keyword=呼吸窘迫综合征，成人), Keyword(id=1208106715720028395, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, language=CN, orderNo=2, keyword=低氧), Keyword(id=1208106715808108783, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, language=CN, orderNo=3, keyword=肺心病), Keyword(id=1208106715896189172, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, language=CN, orderNo=4, keyword=心室功能，右)], refs=[Reference(id=1208106716407894284, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2018, volume=10, issue=9, pageStart=5394, pageEnd=5404, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=Liu L, Yang Y, Gao Z, journalName=J Thorac Dis, refType=null, unstructuredReference=Liu L, Yang Y, Gao Z, et al. Practice of diagnosis and management of acute respiratory distress syndrome in mainland China: a cross-sectional study[J]. J Thorac Dis, 2018, 10(9): 5394-5404., articleTitle=Practice of diagnosis and management of acute respiratory distress syndrome in mainland China: a cross-sectional study, refAbstract=null), Reference(id=1208106716495974672, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2018, volume=163, issue=null, pageStart=260, pageEnd=265, url=null, language=null, rfNumber=[2], rfOrder=1, authorNames=Kharat A, Hachulla AL, Noble S, journalName=Thromb Res, refType=null, unstructuredReference=Kharat A, Hachulla AL, Noble S, et al. Modern diagnosis of chronic thromboembolic pulmonary hypertension[J]. Thromb Res, 2018, 163:260-265., articleTitle=Modern diagnosis of chronic thromboembolic pulmonary hypertension, refAbstract=null), Reference(id=1208106716584055059, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2021, volume=25, issue=1, pageStart=172, pageEnd=null, url=null, language=null, rfNumber=[3], rfOrder=2, authorNames=Sato R, Dugar S, Cheungpasitporn W, journalName=Crit Care, refType=null, unstructuredReference=Sato R, Dugar S, Cheungpasitporn W, et al. The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis[J]. Crit Care, 2021, 25(1): 172., articleTitle=The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis, refAbstract=null), Reference(id=1208106716701495579, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2020, volume=45, issue=12, pageStart=1309, pageEnd=1314, url=null, language=null, rfNumber=[4], rfOrder=3, authorNames=Zhang RH, Xia JG, Zhan QY, journalName=Med J Chin PLA, refType=null, unstructuredReference=Zhang RH, Xia JG, Zhan QY. Research progress on risk factors and predictive scores of sepsis patients developing into acute respiratory distress syndrome[J]. Med J Chin PLA, 2020, 45(12): 1309-1314., articleTitle=Research progress on risk factors and predictive scores of sepsis patients developing into acute respiratory distress syndrome, refAbstract=null), Reference(id=1208106716814741792, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2020, volume=null, issue=12, pageStart=1309, pageEnd=1314, url=null, language=null, rfNumber=[4], rfOrder=4, authorNames=张芮豪, 夏金根, 詹庆元, journalName=解放军医学杂志, refType=null, unstructuredReference=[张芮豪, 夏金根, 詹庆元. 脓毒症并发急性呼吸窘迫综合征的危险因素及预测评分研究进展[J]. 解放军医学杂志, 2020, 45(12): 1309-1314.], articleTitle=脓毒症并发急性呼吸窘迫综合征的危险因素及预测评分研究进展, refAbstract=null), Reference(id=1208106716965736739, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2020, volume=38, issue=9, pageStart=33, pageEnd=34, url=null, language=null, rfNumber=[5], rfOrder=5, authorNames=Zheng J, Jin M, Wei P, journalName=J Prev Med Chin PLA, refType=null, unstructuredReference=Zheng J, Jin M, Wei P, et al. Clinical analysis of 43 cases of high altitude pulmonary edema treated on site at 4300 m altitude[J]. J Prev Med Chin PLA, 2020, 38(9): 33-34., articleTitle=Clinical analysis of 43 cases of high altitude pulmonary edema treated on site at 4300 m altitude, refAbstract=null), Reference(id=1208106717078982952, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2020, volume=null, issue=9, pageStart=33, pageEnd=34, url=null, language=null, rfNumber=[5], rfOrder=6, authorNames=郑俊, 金玫, 魏平, journalName=解放军医学杂志, refType=null, unstructuredReference=[郑俊, 金玫, 魏平, 等. 海拔4300 m现地救治高原肺水肿43例临床分析[J]. 解放军医学杂志, 2020, 38(9): 33-34.], articleTitle=海拔4300 m现地救治高原肺水肿43例临床分析, refAbstract=null), Reference(id=1208106717200617773, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2021, volume=18, issue=4, pageStart=1692, pageEnd=null, url=null, language=null, rfNumber=[6], rfOrder=7, authorNames=Sydykov A, Mamazhakypov A, Maripov A, journalName=Int J Environ Res Public Health, refType=null, unstructuredReference=Sydykov A, Mamazhakypov A, Maripov A, et al. Pulmonary hypertension in acute and chronic high altitude maladaptation disorders[J]. Int J Environ Res Public Health, 2021, 18(4): 1692., articleTitle=Pulmonary hypertension in acute and chronic high altitude maladaptation disorders, refAbstract=null), Reference(id=1208106717292892468, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2018, volume=145, issue=null, pageStart=145, pageEnd=152, url=null, language=null, rfNumber=[7], rfOrder=8, authorNames=Li Y, Zhang Y, journalName=Respir Med, refType=null, unstructuredReference=Li Y, Zhang Y. Research advances in pathogenesis and prophylactic measures of acute high altitude illness[J]. Respir Med, 2018, 145: 145-152., articleTitle=Research advances in pathogenesis and prophylactic measures of acute high altitude illness, refAbstract=null), Reference(id=1208106717397750072, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2013, volume=4, issue=1, pageStart=1, pageEnd=7, url=null, language=null, rfNumber=[8], rfOrder=9, authorNames=Ma SQ, Wu T Y, Chen Q, journalName=J Med Lab Diagn, refType=null, unstructuredReference=Ma SQ, Wu T Y, Chen Q, et al. Acute respiratory distress syndrome secondary to high-altitude pulmonary edema: A diagnostic study[J]. J Med Lab Diagn, 2013, 4(1): 1-7., articleTitle=Acute respiratory distress syndrome secondary to high-altitude pulmonary edema: A diagnostic study, refAbstract=null), Reference(id=1208106717523579201, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2014, volume=null, issue=null, pageStart=123, pageEnd=124, url=null, language=null, rfNumber=[9], rfOrder=10, authorNames=Ma SQ, Wu TY, Zhang XF, journalName=Acute severe altitude sickness and multiple organ dysfunction syndrome, refType=null, unstructuredReference=Ma SQ, Wu TY, Zhang XF. Acute severe altitude sickness and multiple organ dysfunction syndrome[M]. Beijing: People's Medical Publishing House, 2014: 123-124., articleTitle=null, refAbstract=null), Reference(id=1208106717615853891, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2014, volume=null, issue=null, pageStart=123, pageEnd=124, url=null, language=null, rfNumber=[9], rfOrder=11, authorNames=马四清, 吴天一, 张雪峰, journalName=急性重症高原病与多器官功能障碍综合征, refType=null, unstructuredReference=[马四清, 吴天一, 张雪峰. 急性重症高原病与多器官功能障碍综合征[M]. 北京: 人民卫生出版社, 2014: 123-124.], articleTitle=null, refAbstract=null), Reference(id=1208106717712322887, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2018, volume=34, issue=6, pageStart=511, pageEnd=517, url=null, language=null, rfNumber=[10], rfOrder=12, authorNames=Chang WT, Hsu CH, Huang TL, journalName=Acta Cardiol Sin, refType=null, unstructuredReference=Chang WT, Hsu CH, Huang TL, et al. MicroRNA-21 is associated with the severity of right ventricular dysfunction in patients with hypoxia-induced pulmonary hypertension[J]. Acta Cardiol Sin, 2018, 34(6): 511-517., articleTitle=MicroRNA-21 is associated with the severity of right ventricular dysfunction in patients with hypoxia-induced pulmonary hypertension, refAbstract=null), Reference(id=1208106717783626061, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2020, volume=26, issue=5, pageStart=414, pageEnd=421, url=null, language=null, rfNumber=[11], rfOrder=13, authorNames=Aryal S, King CS, journalName=Curr Opin Pulm Med, refType=null, unstructuredReference=Aryal S, King CS. Critical care of patients with pulmonary arterial hypertension[J]. Curr Opin Pulm Med, 2020, 26(5): 414-421., articleTitle=Critical care of patients with pulmonary arterial hypertension, refAbstract=null), Reference(id=1208106717913649491, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2018, volume=59, issue=3, pageStart=466, pageEnd=480, url=null, language=null, rfNumber=[12], rfOrder=14, authorNames=Gaur P, Saini S, Vats P, journalName=Endocrine, refType=null, unstructuredReference=Gaur P, Saini S, Vats P, et al. Regulation, signalling and functions of hormonal peptides in pulmonary vascular remodelling during hypoxia[J]. Endocrine, 2018, 59(3): 466-480., articleTitle=Regulation, signalling and functions of hormonal peptides in pulmonary vascular remodelling during hypoxia, refAbstract=null), Reference(id=1208106718018507102, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2021, volume=1304, issue=null, pageStart=21, pageEnd=38, url=null, language=null, rfNumber=[13], rfOrder=15, authorNames=Maietta V, Reyes-García J, Yadav VR, journalName=Adv Exp Med Biol, refType=null, unstructuredReference=Maietta V, Reyes-García J, Yadav VR, et al. Cellular and molecular processes in pulmonary hypertension[J]. Adv Exp Med Biol, 2021, 1304:21-38., articleTitle=Cellular and molecular processes in pulmonary hypertension, refAbstract=null), Reference(id=1208106718131753317, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2019, volume=76, issue=5, pageStart=25, pageEnd=31, url=null, language=null, rfNumber=[14], rfOrder=16, authorNames=Ma J, Ji LH, Li ZQ, journalName=Blood Cells Mol Dis, refType=null, unstructuredReference=Ma J, Ji LH, Li ZQ, et al. Downregulation of intrinsic apoptosis pathway in erythroblasts contributes to excessive erythrocytosis of chronic mountain sickness[J]. Blood Cells Mol Dis, 2019, 76(5): 25-31., articleTitle=Downregulation of intrinsic apoptosis pathway in erythroblasts contributes to excessive erythrocytosis of chronic mountain sickness, refAbstract=null), Reference(id=1208106718215639403, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2019, volume=37, issue=10, pageStart=188, pageEnd=192, url=null, language=null, rfNumber=[15], rfOrder=17, authorNames=Liu XY, Luo YJ, journalName=J Prev Med Chin PLA, refType=null, unstructuredReference=Liu XY, Luo YJ. Research progress of hypoxic pulmonary artery hypertension[J]. J Prev Med Chin PLA, 2019, 37(10): 188-192., articleTitle=Research progress of hypoxic pulmonary artery hypertension, refAbstract=null), Reference(id=1208106718312108405, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2019, volume=37, issue=10, pageStart=188, pageEnd=192, url=null, language=null, rfNumber=[15], rfOrder=18, authorNames=刘鑫源, 罗勇军, journalName=解放军预防医学杂志, refType=null, unstructuredReference=[刘鑫源, 罗勇军. 急性高原(山)病诊断标准的演变历程及最新进展[J]. 解放军预防医学杂志, 2019, 37(10): 188-192.], articleTitle=急性高原(山)病诊断标准的演变历程及最新进展, refAbstract=null), Reference(id=1208106718395994487, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2021, volume=46, issue=6, pageStart=603, pageEnd=608, url=null, language=null, rfNumber=[16], rfOrder=19, authorNames=Ma SQ, Song Q, journalName=Med J Chin PLA, refType=null, unstructuredReference=Ma SQ, Song Q. Research progress on prevention and treatment of high altitude pulmonary edema[J]. Med J Chin PLA, 2021, 46(6): 603-608., articleTitle=Research progress on prevention and treatment of high altitude pulmonary edema, refAbstract=null), Reference(id=1208106718488269181, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2021, volume=null, issue=6, pageStart=603, pageEnd=608, url=null, language=null, rfNumber=[16], rfOrder=20, authorNames=马四清, 宋青, journalName=解放军医学杂志, refType=null, unstructuredReference=[马四清, 宋青. 高原肺水肿防治研究进展[J]. 解放军医学杂志, 2021, 46(6): 603-608.], articleTitle=高原肺水肿防治研究进展, refAbstract=null), Reference(id=1208106718576349574, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2017, volume=196, issue=7, pageStart=822, pageEnd=833, url=null, language=null, rfNumber=[17], rfOrder=21, authorNames=Henderson WR, Chen L, Amato MBP, journalName=Am J Respir Crit Care Med, refType=null, unstructuredReference=Henderson WR, Chen L, Amato MBP, et al. Fifty years of research in ARDS. Respiratory mechanics in acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2017, 196(7): 822-833, articleTitle=Fifty years of research in ARDS. Respiratory mechanics in acute respiratory distress syndrome, refAbstract=null), Reference(id=1208106718647652749, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2016, volume=32, issue=6, pageStart=533, pageEnd=539, url=null, language=null, rfNumber=[18], rfOrder=22, authorNames=MA SQ, Peng SH, HE ZZ, journalName=Chin J Appl Physiol, refType=null, unstructuredReference=MA SQ, Peng SH, HE ZZ, et al. Changes of microcirculation in healthy volunteers and patients with septic shock in Xining[J]. Chin J Appl Physiol, 2016, 32(6): 533-539., articleTitle=Changes of microcirculation in healthy volunteers and patients with septic shock in Xining, refAbstract=null), Reference(id=1208106718748316049, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2018, volume=6, issue=1, pageStart=7028, pageEnd=null, url=null, language=null, rfNumber=[19], rfOrder=23, authorNames=Lin LJ, Ma SQ, Yao YL, journalName=Chest Dis Rep, refType=null, unstructuredReference=Lin LJ, Ma SQ, Yao YL, et al. Study on improvement of recruitment maneuvers and extravascular lung water in oxygenation of high altitude acute respiratory distress syndrome[J]. Chest Dis Rep, 2018, 6(1): 7028., articleTitle=Study on improvement of recruitment maneuvers and extravascular lung water in oxygenation of high altitude acute respiratory distress syndrome, refAbstract=null), Reference(id=1208106718865756568, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2012, volume=40, issue=2, pageStart=455, pageEnd=460, url=null, language=null, rfNumber=[20], rfOrder=24, authorNames=Zhan QY, Sun B, Liang LR, journalName=Crit Care Med, refType=null, unstructuredReference=Zhan QY, Sun B, Liang LR, et al. Early use of noninvasive positive pressure ventilation for acute lung injury: a multicenter randomized controlled trial[J]. Crit Care Med, 2012, 40(2): 455-460., articleTitle=Early use of noninvasive positive pressure ventilation for acute lung injury: a multicenter randomized controlled trial, refAbstract=null), Reference(id=1208106718941254044, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2016, volume=42, issue=5, pageStart=739, pageEnd=749, url=null, language=null, rfNumber=[21], rfOrder=25, authorNames=Vieillard-Baron A, Matthay M, Teboul JL, journalName=Intensive Care Med, refType=null, unstructuredReference=Vieillard-Baron A, Matthay M, Teboul JL, et al. Experts, opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation[J]. Intensive Care Med, 2016, 42(5): 739-749., articleTitle=Experts, opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation, refAbstract=null), Reference(id=1208106719033528736, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2020, volume=186, issue=2, pageStart=30, pageEnd=35, url=null, language=null, rfNumber=[22], rfOrder=26, authorNames=Dzikowska-Diduch O, Kostrubiec M, Kurnicka K, journalName=Thromb Res, refType=null, unstructuredReference=Dzikowska-Diduch O, Kostrubiec M, Kurnicka K, et al. "The post-pulmonary syndrome - results of echocardiographic driven follow up after acute pulmonary embolism"[J]. Thromb Res, 2020, 186(2): 30-35., articleTitle="The post-pulmonary syndrome - results of echocardiographic driven follow up after acute pulmonary embolism", refAbstract=null), Reference(id=1208106719117414821, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2001, volume=29, issue=6, pageStart=1154, pageEnd=1158, url=null, language=null, rfNumber=[23], rfOrder=27, authorNames=Schmitt JM, Vieillard-Baron A, Augarde R, journalName=Critical Care Med, refType=null, unstructuredReference=Schmitt JM, Vieillard-Baron A, Augarde R, et al. Positive end-expiratory pressure titration in acute respiratory distress syndrome patients:impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements[J]. Critical Care Med, 2001, 29(6): 1154-1158., articleTitle=Positive end-expiratory pressure titration in acute respiratory distress syndrome patients:impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements, refAbstract=null), Reference(id=1208106719205495212, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2019, volume=41, issue=8, pageStart=729, pageEnd=733, url=null, language=null, rfNumber=[24], rfOrder=28, authorNames=Ma SQ, Luo YJ, journalName=J Third Mil Med Univ, refType=null, unstructuredReference=Ma SQ, Luo YJ. Progress in diagnosis and treatment of high-altitude acute respiratory distress syndrome[J]. J Third Mil Med Univ, 2019, 41(8): 729-733., articleTitle=Progress in diagnosis and treatment of high-altitude acute respiratory distress syndrome, refAbstract=null), Reference(id=1208106719306158512, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2019, volume=41, issue=8, pageStart=729, pageEnd=733, url=null, language=null, rfNumber=[24], rfOrder=29, authorNames=马四清, 罗勇军, journalName=第三军医大学学报, refType=null, unstructuredReference=[马四清, 罗勇军. 高原急性呼吸窘迫综合征诊断与治疗进展[J]. 第三军医大学学报, 2019, 41(8): 729-733.], articleTitle=高原急性呼吸窘迫综合征诊断与治疗进展, refAbstract=null), Reference(id=1208106719373267380, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2016, volume=61, issue=10, pageStart=1391, pageEnd=1396, url=null, language=null, rfNumber=[25], rfOrder=30, authorNames=Paternot A, Repessé X, Vieillard-Baron A, journalName=Respir Care, refType=null, unstructuredReference=Paternot A, Repessé X, Vieillard-Baron A. Rationale and description of right ventricle-protective ventilation in ARDS[J]. Respir Care, 2016, 61(10): 1391-1396., articleTitle=Rationale and description of right ventricle-protective ventilation in ARDS, refAbstract=null), Reference(id=1208106719461347769, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2020, volume=48, issue=12, pageStart=1729, pageEnd=1736, url=null, language=null, rfNumber=[26], rfOrder=31, authorNames=Lee HY, Cho J, Kwak N, journalName=Crit Care Med, refType=null, unstructuredReference=Lee HY, Cho J, Kwak N, et al. Improved oxygenation after prone positioning may be a predictor of survival in patients with acute respiratory distress syndrome[J]. Crit Care Med, 2020, 48(12): 1729-1736., articleTitle=Improved oxygenation after prone positioning may be a predictor of survival in patients with acute respiratory distress syndrome, refAbstract=null), Reference(id=1208106719578788284, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2020, volume=75, issue=6, pageStart=791, pageEnd=792, url=null, language=null, rfNumber=[27], rfOrder=32, authorNames=Colla J, Rodos A, Seyller H, journalName=Ann Emerg Med, refType=null, unstructuredReference=Colla J, Rodos A, Seyller H, et al. Fighting COVID-19 hypoxia with one hand tied behind our back:blanket prohibition of high-flow oxygen and noninvasive positive end-expiratory pressure in US[J]. Ann Emerg Med, 2020, 75(6): 791-792., articleTitle=Fighting COVID-19 hypoxia with one hand tied behind our back:blanket prohibition of high-flow oxygen and noninvasive positive end-expiratory pressure in US, refAbstract=null), Reference(id=1208106719683645889, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2021, volume=33, issue=2, pageStart=161, pageEnd=164, url=null, language=null, rfNumber=[28], rfOrder=33, authorNames=Han JH, Ma SQ, Sun B, journalName=Chin Crit Care Med, refType=null, unstructuredReference=Han JH, Ma SQ, Sun B, et al. Continuous prone position ventilation in patients with severe acute respiratory distress syndrome at high altitude[J]. Chin Crit Care Med, 2021, 33(2): 161-164., articleTitle=Continuous prone position ventilation in patients with severe acute respiratory distress syndrome at high altitude, refAbstract=null), Reference(id=1208106719763337671, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2021, volume=null, issue=2, pageStart=161, pageEnd=164, url=null, language=null, rfNumber=[28], rfOrder=34, authorNames=韩进海, 马四清, 孙斌, journalName=中华危重病急救医学, refType=null, unstructuredReference=[韩进海, 马四清, 孙斌, 等. 持续俯卧位通气在高原重度急性呼吸窘迫综合征患者救治中的应用[J]. 中华危重病急救医学, 2021, 33(2): 161-164.], articleTitle=持续俯卧位通气在高原重度急性呼吸窘迫综合征患者救治中的应用, refAbstract=null), Reference(id=1208106719872389578, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2021, volume=56, issue=3, pageStart=636, pageEnd=648, url=null, language=null, rfNumber=[29], rfOrder=35, authorNames=Coleman RD, Chartan CA, Mourani PM, journalName=Pediatr Pulmonol, refType=null, unstructuredReference=Coleman RD, Chartan CA, Mourani PM. Intensive care management of right ventricular failure and pulmonary hypertension crises[J]. Pediatr Pulmonol, 2021, 56(3): 636-648., articleTitle=Intensive care management of right ventricular failure and pulmonary hypertension crises, refAbstract=null), Reference(id=1208106719960469966, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, doi=null, pmid=null, pmcid=null, year=2022, volume=47, issue=2, pageStart=146, pageEnd=156, url=null, language=null, rfNumber=[30], rfOrder=36, authorNames=Zhao QH, Guo N, Chen J, journalName=J Clin Pharm Ther, refType=null, unstructuredReference=Zhao QH, Guo N, Chen J, et al. Comparative assessment of efficacy and safety of ambrisentan and bosentan in patients with pulmonary arterial hypertension: A meta-analysis[J]. J Clin Pharm Ther, 2022, 47(2): 146-156., articleTitle=Comparative assessment of efficacy and safety of ambrisentan and bosentan in patients with pulmonary arterial hypertension: A meta-analysis, refAbstract=null)], funds=[Fund(id=1208106716223344899, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, awardId=81860351, language=EN, fundingSource=National Natural Science Foundation of China(81860351), fundOrder=null, country=null), Fund(id=1208106716307230984, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, awardId=81860351, language=CN, fundingSource=国家自然科学基金(81860351), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1208106714906333377, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, xref=null, ext=[AuthorCompanyExt(id=1208106714914721986, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, companyId=1208106714906333377, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Critical Care Medicine, Qinghai Provincial People's Hospital, Xining 810007, China), AuthorCompanyExt(id=1208106714918916292, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, companyId=1208106714906333377, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=青海省人民医院重症医学科，西宁 810007)])], figs=[ArticleFig(id=1208106716047184121, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, language=EN, label=Tab.1, caption=

Comparison of the difference between plateau ARDS and plain ARDS

, figureFileSmall=null, figureFileBig=null, tableContent=
参数平原ARDS高原ARDS
病因严重创伤、感染、休克、误吸等前述病因+低氧因素
氧合指数血气分析仪测得值需要矫正(760/当地大气压×测得的氧合指数)
肺动脉压较低较高
肺渗出较轻较重
低氧血症明显更加明显
急性肺心病出现易出现
右心损害较轻较重
容量管理自由保守
PEEP设置较高较低
潮气量设置较高较低
俯卧位通气时间较短较长
), ArticleFig(id=1208106716105904381, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106714071666825, language=CN, label=表1, caption=

高原ARDS与平原ARDS的差异

, figureFileSmall=null, figureFileBig=null, tableContent=
参数平原ARDS高原ARDS
病因严重创伤、感染、休克、误吸等前述病因+低氧因素
氧合指数血气分析仪测得值需要矫正(760/当地大气压×测得的氧合指数)
肺动脉压较低较高
肺渗出较轻较重
低氧血症明显更加明显
急性肺心病出现易出现
右心损害较轻较重
容量管理自由保守
PEEP设置较高较低
潮气量设置较高较低
俯卧位通气时间较短较长
)], attaches=null, journal=Journal(id=1146441329971666965, delFlag=0, nameCn=解放军医学杂志, nameEn=Medical Journal of Chinese People’s Liberation Army, nameHistory1=null, nameHistory2=null, issn=0577-7402, eissn=null, cn=11-1056/R, coden=null, periodic=0, language=CN, oaType=是, ccby=CC BY-NC-ND, superviseOffice=null, ownerOffice=null, pubOffice=null, editorOffice=null, officeType=null, aims=null, clcCode=null, officeProv=null, officeCity=null, officeAddr=null, officeZip=null, officeEmail=null, officePhone=null, editDirector=null, officeDirector=null, officeDirectorPhone=null, officeStaffNum=null, officeEmpNum=null, coverPicUrl=6srot5PcoYX30Oa4xeTmeg==, journalPrice=null, startedYear=null, abbrevIsoEn=null, journalRemark=null, publicationField=null, createdTime=1751262512917, updatedTime=1761735725513, createdBy=18614031015, updatedBy=13701087609, firstLetterCn=M, firstLetterEn=M, subjectCode=Life Sciences, subjectName=Life Sciences, subjectCodeEn=Life Sciences, subjectNameEn=null, picCn=6srot5PcoYX30Oa4xeTmeg==, picEn=ELwBh5xqrSTlIs7HmSNt2Q==, jcr=null, cjcr=null, exts=[JournalExt(id=1190369167564968109, language=CN, name=解放军医学杂志, nameHistory1=null, nameHistory2=null, managedBy=, sponsoredBy=, publishedBy=, editorOffice=, officeProv=null, officeCity=null, officeAddr=, officeZip=, editDirector=, officeDirector=null, officePhone=null, coverPicUrl=null, journalRemark=, submitArticleUrl=null, websiteUrl=, createdTime=1761735725537, updatedTime=1761735725537, createdBy=13701087609, updatedBy=13701087609, submissionGuidelinesUrl=, submissionAuthorUrl=#, submissionEditorUrl=#, submissionReviewUrl=#, submissionCeEditorUrl=, submissionAeEditorUrl=, option={"copyright":""}), JournalExt(id=1190369167615299758, language=EN, name=Medical Journal of Chinese People’s Liberation Army, nameHistory1=null, nameHistory2=null, managedBy=, sponsoredBy=, publishedBy=, editorOffice=, officeProv=null, officeCity=null, officeAddr=, officeZip=, editDirector=, officeDirector=null, officePhone=null, coverPicUrl=null, journalRemark=, submitArticleUrl=null, websiteUrl=, createdTime=1761735725549, updatedTime=1761735725549, createdBy=13701087609, updatedBy=13701087609, submissionGuidelinesUrl=, submissionAuthorUrl=#, submissionEditorUrl=#, submissionReviewUrl=#, submissionCeEditorUrl=, submissionAeEditorUrl=, option={"copyright":""})], databaseList=null, tenantJournalId=1189873630562394117, websiteList=[Website(id=1189873845923287108, webName=null, webTitle=null, webDomain=null, webCopyrigh=null, webIpcNo=null, seoTitle=null, seoKeywords=null, seoDescription=null, tenantJournalId=null, journalId=1189873630562394117, journalNameCn=null, journalNameEn=null, grayFlag=null, tenantId=1146029695717560320, platformId=null, journalGroupId=null, journalGroupNameCn=null, journalGroupNameEn=null, type=1, domain=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN, language=CN, createTime=1761617631655, createBy=18614031015, updateTime=1761622010471, updateBy=18614031015, name=解放军医学杂志-中文, tplId=1146099689490845704, title=解放军医学杂志, delFlag=0, indexPage=/home, props=[WebsiteProps(id=1189924939378520839, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=articleTextType, value=kx, createTime=1761629813284, updateTime=1761629813284, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939353355012, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=banner, value=null, createTime=1761629813278, updateTime=1761629813278, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939399492362, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=grayFlag, value=0, createTime=1761629813289, updateTime=1761629813289, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939344966403, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=logo, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/file/pic?fileId=+zXjYVhun8ZOAA6+aKx2hw==, createTime=1761629813276, updateTime=1761629813276, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939412075276, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=minRunFlag, value=0, createTime=1761629813292, updateTime=1761629813292, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939374326534, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=picServerUrl, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/file/pic, createTime=1761629813283, updateTime=1761629813283, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939407880971, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=silenceFlag, value=0, createTime=1761629813291, updateTime=1761629813291, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939361743621, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=staticResourcePath, value=https://castjournals.cast.org.cn/joweb/cast_kjdb_cn_619/, createTime=1761629813280, updateTime=1761629813280, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939386909448, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=themeColor, value=null, createTime=1761629813286, updateTime=1761629813286, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924939395298057, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873845923287108, code=themeStyle, value=null, createTime=1761629813288, updateTime=1761629813288, creator=18614031015, updator=18614031015)]), Website(id=1189873846057504839, webName=null, webTitle=null, webDomain=null, webCopyrigh=null, webIpcNo=null, seoTitle=null, seoKeywords=null, seoDescription=null, tenantJournalId=null, journalId=1189873630562394117, journalNameCn=null, journalNameEn=null, grayFlag=null, tenantId=1146029695717560320, platformId=null, journalGroupId=null, journalGroupNameCn=null, journalGroupNameEn=null, type=1, domain=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN, language=EN, createTime=1761617631687, createBy=18614031015, updateTime=1761622030030, updateBy=18614031015, name=解放军医学杂志-英文, tplId=1146101810881728533, title=Medical Journal of Chinese People’s Liberation Army, delFlag=0, indexPage=/home, props=[WebsiteProps(id=1189924968168223505, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=articleTextType, value=kx, createTime=1761629820148, updateTime=1761629820148, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968147251982, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=banner, value=null, createTime=1761629820143, updateTime=1761629820143, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968185000724, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=grayFlag, value=0, createTime=1761629820152, updateTime=1761629820152, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968138863373, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=logo, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/file/pic?fileId=+zXjYVhun8ZOAA6+aKx2hw==, createTime=1761629820141, updateTime=1761629820141, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968197583638, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=minRunFlag, value=0, createTime=1761629820155, updateTime=1761629820155, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968159834896, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=picServerUrl, value=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/file/pic, createTime=1761629820146, updateTime=1761629820146, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968193389333, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=silenceFlag, value=0, createTime=1761629820154, updateTime=1761629820154, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968155640591, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=staticResourcePath, value=https://castjournals.cast.org.cn/joweb/cast_kjdb_en_623/, createTime=1761629820145, updateTime=1761629820145, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968172417810, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=themeColor, value=null, createTime=1761629820149, updateTime=1761629820149, creator=18614031015, updator=18614031015), WebsiteProps(id=1189924968180806419, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1189873846057504839, code=themeStyle, value=null, createTime=1761629820151, updateTime=1761629820151, creator=18614031015, updator=18614031015)])], journalTitle=解放军医学杂志, weixinUrl=null, journalUrl=http://zh.jfjyxzz.org.cn/, iacademicId=null, status=1, seqNo=null, journalTitleEn=Medical Journal of Chinese People’s Liberation Army, journalPhotoCn=6srot5PcoYX30Oa4xeTmeg==, journalPhotoEn=ELwBh5xqrSTlIs7HmSNt2Q==, journalFirstLetter=M, journalRecommend=null, journalNew=null, journalCollection=null, jcrJf=null, cjcrJf=null, jcrJfStr=null, cjcrJfStr=null, submissionFirstDecision=null, sciSubjectClassification=null, casSubjectClassification=null, citeScore=null, totalCitationFrequency=null, icpCode=null, psCode=null, advertisingLicenseCode=null, copyrightInformation=null, country=null, option=, provinceCode=null, provinceName=null, collectFlag=false), detailUrlCn=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.2022.04.0321, detailUrlEn=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/10.11855/j.issn.0577-7402.2022.04.0321, pdfUrlCn=https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/PDF/10.11855/j.issn.0577-7402.2022.04.0321, pdfUrlEn=https://castjournals.cast.org.cn/joweb/jfjyxzz/EN/PDF/10.11855/j.issn.0577-7402.2022.04.0321, aliStartDate=null, aliEndDate=null, collectionFlag=false, citedCount=null, citedUrl=null, reference=null)
收藏切换
高原慢性低氧暴露下的急性呼吸窘迫综合征：更应关注右心功能
收藏切换
PDF下载
马四清
解放军医学杂志 | 专家述评 2022,47(4): 321-325
收起
收藏切换
解放军医学杂志 | 专家述评 2022, 47(4): 321-325
高原慢性低氧暴露下的急性呼吸窘迫综合征：更应关注右心功能
全屏
马四清
作者信息
  • 青海省人民医院重症医学科，西宁 810007

    • 马四清，主任医师，中华医学会高原医学分会常委、危重病学组组长，青海省重症医学分会主任委员，国家卫生计生突出贡献中青年专家，青海省“昆仑英才·高端创新创业人才”杰出人才。

Acute respiratory distress syndrome following chronic hypoxic exposure: more attention should be paid to right ventricular function at high altitude
Si-Qing Ma
Affiliations
  • Department of Critical Care Medicine, Qinghai Provincial People's Hospital, Xining 810007, China
出版时间: 2022-04-28 doi: 10.11855/j.issn.0577-7402.2022.04.0321
文章导航
收藏切换
摘要
收起

急性呼吸窘迫综合征(ARDS)时肺血管收缩、肺血管阻力增加、肺动脉高压，导致患者右心后负荷过高，继而并发急性肺心病(ACP)，加重右心功能损害，出现严重肺水肿及低氧血症。长期暴露在高原慢性低氧环境的健康人，极易出现生理性肺动脉高压及血液黏滞度改变等，这些因素会加重高原ARDS的严重程度。因此，高原ARDS与平原ARDS的病理生理变化有所不同，诊断标准、临床表现、病情严重程度也不一致。本文从高原ARDS的病理生理机制出发，探讨右心功能损害的影响因素，提出高原慢性低氧暴露下的ARDS更应关注右心功能的监测与保护，优化呼吸支持治疗、肺血管扩张治疗、抗凝治疗等，以减少治疗中的再损伤，提高ARDS救治的存活率。

呼吸窘迫综合征，成人  /  低氧  /  肺心病  /  心室功能，右

During acute respiratory distress syndrome (ARDS) occurs, the pulmonary vasoconstriction increased pulmonary vascular resistance, led to pulmonary arterial hypertension and excessive right ventricular afterload, followed by acute corpulmonale(ACP), aggravated right ventricular function damage, bring about pulmonary edema and hypoxemia, those are the important causes lead to patient death. Healthy people exposed to chronic hypoxia at high altitude for a long period prone to physiological pulmonary hypertension and change of blood viscosity, thus aggravating the severity of ARDS at high altitude. Therefore, the pathophysiological changes of ARDS are different in plateau to that in plain areas, and the diagnostic criteria, clinical manifestations and severity of the disease are also different. In present paper, the factors affecting the aggravation of right heart damage were discussed from a pathophysiological point, and a proposal was made that monitoring and protection of right ventricular function should be paid more attention in plateau and hypoxia environment for ARDS patient, optimizing respiratory support therapy, pulmonary vasodilation therapy and anticoagulant therapy for reducing the iatrogenic injury in treatment and improving the survival rate of ARDS patients.

respiratory distress syndrome, adult  /  hypoxia  /  corpulmonale  /  ventricular function, right
马四清. 高原慢性低氧暴露下的急性呼吸窘迫综合征：更应关注右心功能. 解放军医学杂志, 2022 , 47 (4) : 321 -325 . DOI: 10.11855/j.issn.0577-7402.2022.04.0321
Si-Qing Ma. Acute respiratory distress syndrome following chronic hypoxic exposure: more attention should be paid to right ventricular function at high altitude[J]. Medical Journal of Chinese People’s Liberation Army, 2022 , 47 (4) : 321 -325 . DOI: 10.11855/j.issn.0577-7402.2022.04.0321
正文
收起
急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)，尤其是重症ARDS易继发循环衰竭，并可能与严重低氧血症并存，是患者死亡的主要原因之一[1]。ARDS发生时，通过缺氧性肺血管收缩、间质水肿压迫血管、血管重塑、血液黏滞度增加以及血栓栓塞等病理生理机制，使肺血管阻力(pulmonary vascular resistance，PVR)升高，引起肺动脉高压(pulmonary arterial hypertension，PAH)，右心后负荷增加，最终导致右心衰竭，出现急性肺心病(acute corpulmonale，ACP)[2]，并引起急性心功能障碍，是循环衰竭发生的重要原因。一项纳入352例ARDS患者的回顾性研究发现，ARDS患者病死率增高与ACP的发生发展密切相关[3]。处于长期慢性低氧环境的人群会出现继发性PAH、高血红蛋白、血液黏滞度增加等生理改变，这类人群遭受严重创伤、感染、急性缺氧等病理性因素后，发生ARDS的诊断标准及治疗策略应与平原不一致[4]。此时，若仍遵循平原ARDS的标准进行治疗，可能会造成医源性损伤。本文从高原ARDS的病理生理机制出发，探讨右心功能损害的影响因素，并提出可能的保护措施。
1 慢性低氧暴露与高原病
收起
长期暴露于慢性低氧环境的健康人群，机体会出现许多生理变化，如红细胞逐渐增多、肺动脉压力增高等，并会继发慢性高原病，包括高原红细胞增多症(high altitude polycythemia，HAPC)及高原肺动脉高压(high altitude pulmonary hypertension，HAPH)。HAPC主要是由于促红细胞生成素(erythropoietin，EPO)过度释放导致红细胞生成增多，使血液黏滞度异常升高，造成微循环障碍，组织严重缺氧，易导致血栓形成或局部组织坏死等并发症[5]。HAPH是一种高原特发病，表现为平均肺动脉压>30 mmHg(1 mmHg≈0.133 kPa)或肺动脉收缩压>50 mmHg，右心室肥大，中度低氧血症等。长期缺氧引起肺血管持续收缩及结构改变是HAPH发病的中心环节[6]及主要机制[7]。
2 慢性低氧环境下的ARDS特征
收起
2.1 高原ARDS诊断标准中氧合指数的校正
随着海拔的升高，大气氧分压降低，人体动脉血氧分压会随之下降。对于发生在高原的ARDS，如果仍按平原ARDS的标准进行诊断，可能在严重程度分层方面出现假阳性，因此需要制定适合高原ARDS的诊疗标准。在柏林标准中已强调如果海拔>1000 m，需要对氧合指数进行校正[8]。校正方法为：在标准大气条件下海平面的气压为760 mmHg，随着海拔升高，大气压逐渐下降，海拔每升高12 m，大气压下降1 mmHg，校正氧合指数=760/实际海拔×实际测得的氧合指数[9]。
2.2 高原ARDS的病理生理特点
2.2.1 肺动脉压力增高
慢性低氧环境下发生ARDS时，肺血管阻力及肺动脉压力均明显增高[10]，其主要机制为：(1)低氧性肺血管收缩(HPV)引起PAH。肺动脉平滑肌细胞中钙浓度的增加及Rho激酶介导的敏化是HPV的主要机制之一[11-12]，同时内皮细胞损伤导致血管扩张介质(NO、前列环素)与血管收缩介质(血栓素、白三烯、内皮素、5-羟色胺、血管紧张素Ⅱ)的平衡发生改变，也会导致HPV的发生[13]。(2)血液黏滞度增高加重PAH。在过表达重组人促红细胞生成素(rhEPO)的转基因大鼠中证实，单纯红细胞增多可以引起PAH，EPO诱导的红细胞增多症增加了血液黏度及肺血管阻力，参与了缺氧性PAH的形成[14]。红细胞增多会使全血量增加，引起心脏负荷增加，加重PAH，这种表现在HAPC中尤为明显[15]。血栓栓塞、血管重塑均会使PVR增高，加剧PAH[16]。HPV及血液黏滞度增高等多种因素导致慢性低氧环境下的ARDS肺血管阻力及肺动脉压力较常氧环境下明显增高，增加了右心后负荷，易发生ACP。有研究显示，20%~25%的ARDS患者合并ACP[17]。
2.2.2 肺毛细血管通透性增加
低氧环境下，血管内皮细胞生长因子(VEGF)表达增加[18]。当机体遭受严重缺氧、创伤、感染等因素损害时，肺泡壁被破坏，血管内皮损伤，组织间裂隙增宽，通透性增加，出现毛细血管渗漏综合征，加重了肺水肿，可进一步导致低氧血症，这是慢性低氧环境下ARDS的显著病理生理特征[19]。
2.3 高原ARDS的治疗策略
2.3.1 纠正低氧血症，改善右心功能
低氧血症是ARDS的主要表现，持续的低氧血症会进一步损害患者的右心功能及其他器官功能。临床上应根据低氧血症的严重程度，依次采用面罩吸氧、经鼻高流量氧疗、无创通气及有创通气等氧疗方式进行治疗[20]。随着患者低氧血症的缓解，其右心功能乃至左心功能也能得到明显改善，进而减轻ARDS的临床症状，改善预后。
2.3.2 合理设置潮气量及呼气末正压(PEEP)
在对高原ARDS患者实施机械通气治疗时，应当积极关注其右心功能。潮气量是影响后负荷的决定因素，过大可使跨肺压增高，PVR增高，右心室后负荷显著增加，进而引起右心功能不全[21]；PEEP在吸气相和呼气相均增加右心室负荷，急剧增加的右心室后负荷导致右心室收缩期延长，收缩末跨室间隔压力梯度逆转，右心室扩张[22]。目前临床医师设置PEEP的依据主要基于2000年急性呼吸窘迫综合征网络(ARDSnet)推荐的表格法及跨肺压监测[23]，通过这两种方法设置的PEEP在高原ARDS中并不合适。按此设置，会导致平台压>28 cmH2O(1 cmH2O≈0.098 kPa)，驱动压>15 cmH2O，对高原ARDS极为不利，平台压越高右心功能损害越明显，更容易引起ACP。笔者认为，在慢性低氧ARDS患者中，PEEP及潮气量设置的主要依据是维持平台压<25 cmH2O，驱动压<15 cmH2O，二氧化碳分压<48 mmHg且pH值>7.25，依此标准能明显提高ARDS患者的存活率。
2.3.3 重视血容量管理
高原ARDS的特征主要为PAH，右心室功能易出现明显损害，考虑到右心室舒张末期压力-容量的双曲线，当右心室已经扩张时，由于红细胞明显增多，造成血液黏滞度增加，容量治疗的窗口特别窄，前负荷稍微增加，其舒张末期的压力就增加得非常明显。右侧压力增加，致使一些重要器官灌注的末端压力增高，会对肾脏等器官的功能造成负面影响。部分健康人急进至海拔3000 m以上高原时，会发生间质性肺水肿及肺泡性肺水肿，主要原因是急性缺氧导致肺血管收缩、PAH、心脏泵功能下降、组织缺氧、代谢障碍、毛细血管通透性增加等，同时红细胞增生、血红蛋白增加、肺血容量增加，此时如果再输入过多的液体，就容易导致肺水肿的发生[24]。
2.3.4 早期俯卧位通气
为缓解及保护慢性低氧环境下ARDS患者的右心及左心功能，持续俯卧位通气是一项非常有效的措施[25]。俯卧位通气可改善肺的应变应力，减轻肺部甚至全身的炎症反应，从而改善细胞因子释放导致的心功能损害。同时俯卧位通气可使肺通气更均匀，改善氧合，降低二氧化碳分压[26]。可通过肺重力依赖区的背区复张以降低驱动压来纠正右心衰竭[27]。笔者的经验是在氧合指数低于150 mmHg，甚至在无创通气时就实施俯卧位通气，而且要延长俯卧位的持续时间，甚至通过左右侧俯卧位交替的方式达到24 h持续俯卧位通气，连续3 d以上，直至肺顺应性及氧合明显改善[28]。
2.3.5 早期应用降低PAH的药物
早期应用内皮素受体拮抗剂波生坦及左西孟旦可明显降低PAH，保护右心功能[29-30]。
3 总结与展望
收起
高原ARDS的诊断标准、病理生理及治疗策略与平原ARDS均有明显不同(表1)，在临床应用中应区别对待，精准治疗。
ARDS是临床治疗的难点，也是基础及临床研究的热点。长期暴露于低氧环境下的健康人群，其许多生理指标与平原人群明显不同，主要表现为生理性的PAH、血液黏滞度升高、微循环血流速度减慢、微血管密度增加等。长期低氧，再加上发生ARDS时炎性因子、血管紧张素等直接因素对肺微血管内皮细胞的损伤，以及急性低氧、肺血管异常(肺血管的压迫、肺血管的阻塞、肺血管重塑、肺血管舒缩功能障碍)等间接因素导致的PAH，致使高原ARDS的病理生理具有一定的特殊性。慢性低氧暴露下的ARDS容易发生急性肺心病，右心功能会受到明显损害，最终导致右心衰竭。急性右心功能损害使左心前负荷减少，同时右心的容积或压力升高均通过室间隔传递给左心，从而影响左心射血能力，出现左心功能障碍，进一步发展可导致全心功能损害。血液黏滞度的增加会使肺血容量增加，此时不恰当的输液等治疗会增加肺血流量，加重或诱发肺水肿，出现更严重的低氧血症及呼吸衰竭。因此，在临床治疗中必须了解并掌握慢性低氧暴露下ARDS的病理生理特征，更应关注右心功能的监测及保护，优化呼吸支持治疗、肺血管扩张治疗、抗凝治疗等，减少治疗中的再损伤，提高ARDS的救治存活率。
基金
收起
  • 国家自然科学基金(81860351)
文献
收起
参考文献 引证文献
排序方式：
[1]
Liu L, Yang Y, Gao Z, et al. Practice of diagnosis and management of acute respiratory distress syndrome in mainland China: a cross-sectional study[J]. J Thorac Dis, 2018, 10(9): 5394-5404.
[2]
Kharat A, Hachulla AL, Noble S, et al. Modern diagnosis of chronic thromboembolic pulmonary hypertension[J]. Thromb Res, 2018, 163:260-265.
[3]
Sato R, Dugar S, Cheungpasitporn W, et al. The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis[J]. Crit Care, 2021, 25(1): 172.
[4]
Zhang RH, Xia JG, Zhan QY. Research progress on risk factors and predictive scores of sepsis patients developing into acute respiratory distress syndrome[J]. Med J Chin PLA, 2020, 45(12): 1309-1314.
[张芮豪, 夏金根, 詹庆元. 脓毒症并发急性呼吸窘迫综合征的危险因素及预测评分研究进展[J]. 解放军医学杂志, 2020, 45(12): 1309-1314.]
[5]
Zheng J, Jin M, Wei P, et al. Clinical analysis of 43 cases of high altitude pulmonary edema treated on site at 4300 m altitude[J]. J Prev Med Chin PLA, 2020, 38(9): 33-34.
[郑俊, 金玫, 魏平, 等. 海拔4300 m现地救治高原肺水肿43例临床分析[J]. 解放军医学杂志, 2020, 38(9): 33-34.]
[6]
Sydykov A, Mamazhakypov A, Maripov A, et al. Pulmonary hypertension in acute and chronic high altitude maladaptation disorders[J]. Int J Environ Res Public Health, 2021, 18(4): 1692.
[7]
Li Y, Zhang Y. Research advances in pathogenesis and prophylactic measures of acute high altitude illness[J]. Respir Med, 2018, 145: 145-152.
[8]
Ma SQ, Wu T Y, Chen Q, et al. Acute respiratory distress syndrome secondary to high-altitude pulmonary edema: A diagnostic study[J]. J Med Lab Diagn, 2013, 4(1): 1-7.
[9]
Ma SQ, Wu TY, Zhang XF. Acute severe altitude sickness and multiple organ dysfunction syndrome[M]. Beijing: People's Medical Publishing House, 2014: 123-124.
[马四清, 吴天一, 张雪峰. 急性重症高原病与多器官功能障碍综合征[M]. 北京: 人民卫生出版社, 2014: 123-124.]
[10]
Chang WT, Hsu CH, Huang TL, et al. MicroRNA-21 is associated with the severity of right ventricular dysfunction in patients with hypoxia-induced pulmonary hypertension[J]. Acta Cardiol Sin, 2018, 34(6): 511-517.
[11]
Aryal S, King CS. Critical care of patients with pulmonary arterial hypertension[J]. Curr Opin Pulm Med, 2020, 26(5): 414-421.
[12]
Gaur P, Saini S, Vats P, et al. Regulation, signalling and functions of hormonal peptides in pulmonary vascular remodelling during hypoxia[J]. Endocrine, 2018, 59(3): 466-480.
[13]
Maietta V, Reyes-García J, Yadav VR, et al. Cellular and molecular processes in pulmonary hypertension[J]. Adv Exp Med Biol, 2021, 1304:21-38.
[14]
Ma J, Ji LH, Li ZQ, et al. Downregulation of intrinsic apoptosis pathway in erythroblasts contributes to excessive erythrocytosis of chronic mountain sickness[J]. Blood Cells Mol Dis, 2019, 76(5): 25-31.
[15]
Liu XY, Luo YJ. Research progress of hypoxic pulmonary artery hypertension[J]. J Prev Med Chin PLA, 2019, 37(10): 188-192.
[刘鑫源, 罗勇军. 急性高原(山)病诊断标准的演变历程及最新进展[J]. 解放军预防医学杂志, 2019, 37(10): 188-192.]
[16]
Ma SQ, Song Q. Research progress on prevention and treatment of high altitude pulmonary edema[J]. Med J Chin PLA, 2021, 46(6): 603-608.
[马四清, 宋青. 高原肺水肿防治研究进展[J]. 解放军医学杂志, 2021, 46(6): 603-608.]
[17]
Henderson WR, Chen L, Amato MBP, et al. Fifty years of research in ARDS. Respiratory mechanics in acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2017, 196(7): 822-833
[18]
MA SQ, Peng SH, HE ZZ, et al. Changes of microcirculation in healthy volunteers and patients with septic shock in Xining[J]. Chin J Appl Physiol, 2016, 32(6): 533-539.
[19]
Lin LJ, Ma SQ, Yao YL, et al. Study on improvement of recruitment maneuvers and extravascular lung water in oxygenation of high altitude acute respiratory distress syndrome[J]. Chest Dis Rep, 2018, 6(1): 7028.
[20]
Zhan QY, Sun B, Liang LR, et al. Early use of noninvasive positive pressure ventilation for acute lung injury: a multicenter randomized controlled trial[J]. Crit Care Med, 2012, 40(2): 455-460.
[21]
Vieillard-Baron A, Matthay M, Teboul JL, et al. Experts, opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation[J]. Intensive Care Med, 2016, 42(5): 739-749.
[22]
Dzikowska-Diduch O, Kostrubiec M, Kurnicka K, et al. "The post-pulmonary syndrome - results of echocardiographic driven follow up after acute pulmonary embolism"[J]. Thromb Res, 2020, 186(2): 30-35.
[23]
Schmitt JM, Vieillard-Baron A, Augarde R, et al. Positive end-expiratory pressure titration in acute respiratory distress syndrome patients:impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements[J]. Critical Care Med, 2001, 29(6): 1154-1158.
[24]
Ma SQ, Luo YJ. Progress in diagnosis and treatment of high-altitude acute respiratory distress syndrome[J]. J Third Mil Med Univ, 2019, 41(8): 729-733.
[马四清, 罗勇军. 高原急性呼吸窘迫综合征诊断与治疗进展[J]. 第三军医大学学报, 2019, 41(8): 729-733.]
[25]
Paternot A, Repessé X, Vieillard-Baron A. Rationale and description of right ventricle-protective ventilation in ARDS[J]. Respir Care, 2016, 61(10): 1391-1396.
[26]
Lee HY, Cho J, Kwak N, et al. Improved oxygenation after prone positioning may be a predictor of survival in patients with acute respiratory distress syndrome[J]. Crit Care Med, 2020, 48(12): 1729-1736.
[27]
Colla J, Rodos A, Seyller H, et al. Fighting COVID-19 hypoxia with one hand tied behind our back:blanket prohibition of high-flow oxygen and noninvasive positive end-expiratory pressure in US[J]. Ann Emerg Med, 2020, 75(6): 791-792.
[28]
Han JH, Ma SQ, Sun B, et al. Continuous prone position ventilation in patients with severe acute respiratory distress syndrome at high altitude[J]. Chin Crit Care Med, 2021, 33(2): 161-164.
[韩进海, 马四清, 孙斌, 等. 持续俯卧位通气在高原重度急性呼吸窘迫综合征患者救治中的应用[J]. 中华危重病急救医学, 2021, 33(2): 161-164.]
[29]
Coleman RD, Chartan CA, Mourani PM. Intensive care management of right ventricular failure and pulmonary hypertension crises[J]. Pediatr Pulmonol, 2021, 56(3): 636-648.
[30]
Zhao QH, Guo N, Chen J, et al. Comparative assessment of efficacy and safety of ambrisentan and bosentan in patients with pulmonary arterial hypertension: A meta-analysis[J]. J Clin Pharm Ther, 2022, 47(2): 146-156.
2022年第47卷第4期
PDF下载
283
126
引用本文
BibTeX
文章信息
doi: 10.11855/j.issn.0577-7402.2022.04.0321
  • 接收时间：2021-07-13
  • 首发时间：2025-12-17
  • 出版时间：2022-04-28
补充材料
相关文章
文章信息
作者
出版历史
  • 收稿日期：2021-07-13
  • 录用日期：2022-01-28
基金
National Natural Science Foundation of China(81860351)
国家自然科学基金(81860351)
作者信息
    青海省人民医院重症医学科，西宁 810007
参考文献
分享链接
https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.2022.04.0321
分享至
全文二维码

扫描看全文

引用本文
BibTeX
本文的引用情况
2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
关闭全屏
相关链接
论文
最新文章
热读文章
热点专题
内参
蓝皮书
产业发展报告
传播力报告
期刊分级目录
资讯
学术新闻
行业新闻
学术会议
行业会议
关于
关于我们
联系我们
北京市海淀区学院南路86号
100081
010-62199257
qkjq@cast.org.cn

中国科学技术协会版权所有 京ICP 备10216604号-4 海淀分局备案 1101084647
科技导报社主办 中国科协信息中心技术支持