对急性呼吸窘迫综合征最新全球定义的思考  

Reflections on an Updated Global Definition of Acute Respiratory Distress Syndrome

作　　者：黄伟[1] 代晓明[1] Huang Wei;Dai Xiaoming(Department of Critical Care Medicine,the First Affiliated Hospital of Dalian Medical University,Dalian 116011 China)

机构地区：[1]大连医科大学附属第一医院重症医学科,辽宁大连116011

出　　处：《锦州医科大学学报》2023年第3期1-5,共5页Journal of Jinzhou Medical University

摘　　要：2023年急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)全球定义是对既往概念的扩展,主要变化是诊断对象扩展到HFNO≥30 L/min的患者、低氧血症的判断从动脉血气扩展到指脉氧仪、双侧肺部浸润的判断从胸片和肺CT扩展到肺部超声;在医疗资源不足地区可对呼气末正压(positive end-expiratory pressure,PEEP)、氧流量或特定呼吸支持设备不做要求,这种简单化的推荐有助于早期识别和治疗,但缺乏病情分层以及忽视ARDS“难治性低氧血症”的核心特征是否真能带动全球ARDS临床诊疗以及科学研究格局的关键变化,因此值得继续观察和深入探讨。The global definition of acute respiratory distress syndrome(ARDS)in 2023 is an expansion of the previous concept.The main changes are that the diagnostic objects are extended to patients with HFNO≥30 L/min,the judgment of hypoxemia is expanded from arterial blood gas finger pulse oximeter and the judgment of bilateral pulmonary infiltrates is extended from chest radiography and lung CT to lung ultrasound;positive end-expiratory pressure(PEEP),oxygen flow,or specific respiratory support equipment may not be required in areas with insufficient medical resources.This simplistic recommendation is helpful for early identification and treatment,but whether the lack of disease stratification and ignoring the core characteristics of ARDS"refractory hypoxemia"can really drive key changes in the global ARDS clinical diagnosis and treatment as well as scientific research patterns deserves continued observation and in-depth discussion.

关 键 词：急性呼吸窘迫综合征 诊断 病理生理学 难治性低氧血症 

分 类 号：R563.8[医药卫生—呼吸系统]