一例术后急性呼吸窘迫综合征患者的循证药物治疗  

Evidence-based Pharmacotherapy for Treating a Patient with Acute Respiratory Distress Syndrome after Operation

作　　者：王宾友[1] 董碧蓉[2] 刘雅[1] 何萍[3] 李韫[4] 

机构地区：[1]成都市第二人民医院老年医学科,成都610017 [2]四川大学华西医院老年科,成都610041 [3]成都市第三人民医院呼吸科,成都610031 [4]成都市第二人民医院重症监护室

出　　处：《中国循证医学杂志》2009年第9期1026-1030,共5页Chinese Journal of Evidence-based Medicine

摘　　要：目的为1例手术后发生急性呼吸窘迫综合征(ARDS)的患者制定药物治疗方案。方法根据患者临床状况,提出"液体管理、激素使用"等6个临床问题,通过OVID平台检索ACP Journal Club(1991～2009年)、Cochrane Central Register of Controlled Trials(CENTRAL,2009年第1期)、Cochrane Database of Systematic Reviews(CDSR,2009年第1期)和MEDLINE(1991～2009年)等数据库,根据所获证据给患者制定药物治疗方案。结果最终纳入7篇系统评价,6篇随机对照试验,证据级别为1～2级。现有证据显示:限制性液体管理策略、纠正低蛋白血症、速尿和早期小剂量糖皮质激素的使用可提高氧合,改善患者预后;NO吸入、表面活性物、其他药物不能降低ARDS病死率,不推荐作为ARDS的常规治疗。结合患者情况,应用证据治疗8天后,患者转出重症监护室,1月后康复出院。结论以循证医学的方法,采用高质量证据、结合患者情况制定治疗方案,能提高ARDS疗效,缩短ICU住院时间,降低病死率,减少不良反应的发生。Objective Making an individualized pharmacological treatment plan for a patient of acute respiratory distress syndrome after operation.Methods First,six clinical problems were put forward after assessing the patient s health state.Then we searched OVID versions of the ACP Journal Club（1991～2009）,CENTRAL（1st Quarter 2009）,CDSR（1st Quarter 2009）,and MEDLINE（1991～2009）databases.Systematic reviews,meta-analyses,and randomized clinical trials about treatment of acute respiratory distress syndrome were included.The pharmacological treatment plan was made accordingly,Results After evaluation, 13 studies were eligible. The evidence indicated that the restrictive strategy of fluid management, corrected hypoproteinaemia, diuresis, and low-dose corticosteroids given in the early phase could improve oxygenation and prognosis; inhaled nitric oxide, exogenous surfactant supplement, other pharmacological drugs were associated with limited improvement in oxygenation in patients with ARDS but confer no mortality benefit and may cause harm, so we did not recommend their routine use in ARDS patients. The individual treatment plan was made based on the evidence found. After 8 days of treatment, the patient was out the ICU. He recovered and was discharged after 1 month. Conclusions The individual treatment plan, which was made based on high quality evidence and patient＇s condition, improved treatment efficacy, shortened the stay in ICU. reduced mortality, and decreased adverse reactions.

关 键 词：急性呼吸窘迫综合征 药物治疗 循证治疗 

分 类 号：R563.8[医药卫生—呼吸系统] R969[医药卫生—内科学]