创伤性急性呼吸窘迫综合征及其治疗方法研究进展  

Update in Trauma-induced Acute Respiratory Distress Syndrome and its Therapy

作　　者：刘相德[1] 高燕[2] 

机构地区：[1]美国内布拉斯加大学医学中心呼吸与重症病科 [2]沈阳军区总医院急诊科,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2013年第1期32-41,共10页Trauma and Critical Care Medicine

摘　　要：急性呼吸窘迫综合征(ARDS)是以急性呼吸衰竭为特征的临床综合征。创伤是导致ARDS的第二常见原因。最新ARDS柏林诊断标准提出根据PaO2/FiO2,将ARDS分为轻、中、重度;取消了急性肺损伤(ALI)定义。肺保护性机械通气,即低潮气量(6 mL/kg)、中等呼气末正压(PEEP)通气及平台压<2.94 kPa,能明显改善ARDS生存率,是治疗ARDS最有效的通气方式。控制输液量和俯卧位机械通气对重症ARDS有益。手提式体外膜肺氧合机(ECMO)已开始用于野战医院(美国)。间充质干细胞(MSC)和他汀类药物(statins)有望成为ARDS治疗的有效方法。ARDS生存者心理和机体康复治疗值得重视。Acute respiratory distress syndrome(ARDS) is characterized by acute respiratory failure due to diffuse alveolar injury and severe hypoxemia.Trauma is the second leading cause of ARDS.The current review presents the Berlin Definition of ARDS,which defines ' acute' to be within 1 week or less and ' severity' by oxygenation as mild,moderate and severe,and abandons the term of Acute Lung Injury(ALI).Studies have demonstrated that lung protective ventilation with low tidal volume(6 mL / kg),moderate PEEP and plateau pressure of < 2.94 kPa increases ARDS survival rate,and thus, this strategy is recommended for ARDS treatment.Prone positioning and conservative fluid strategy can improve oxygenation and survival rate of ARDS.Portable extracorporeal membrane oxygenation(ECMO) has recently been implemented in US soldiers with ARDS.Mesenchymal stem cells(MSC) and statins might become new therapeutic tools for ARDS.Psychological and physical rehabilitation after ARDS survival is important to improve quality of life.

关 键 词：创伤 急性呼吸窘迫综合征(ARDS) 急性肺损伤 柏林诊断标准 

分 类 号：R563.8[医药卫生—呼吸系统]