急性呼吸窘迫综合征治疗:现状与未来  

Treatment of acute respiratory distress syndrome:current situation and future

作　　者：常炜 谢剑锋[1] 刘玲[1] 邱海波[1] CHANG Wei;XIE Jian-feng;LIU Ling;QIU Hai-bo(Department of Critical Care Medicine,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院重症医学科,江苏南京210009

出　　处：《实用医院临床杂志》2024年第4期1-5,共5页Practical Journal of Clinical Medicine

基　　金：国家自然科学基金重点项目(编号:81930058);国家自然科学基金专项(编号:82341032);国家重点研发计划“常见多发病防治研究”重点专项(编号:2022YFC2504400)。

摘　　要：急性呼吸窘迫综合征是由不同的遗传背景、环境因素和宿主因素相互作用的一系列表型,在病因、病理生理学、病理表现、临床特征上都具有显著的异质性,这也为治疗带来了诸多的难点;根据炎症反应程度、病理生理特点、影像学表现和组学差异等表型导向的急性呼吸窘迫综合征个体化、精准化治疗可能是未来的治疗方向。呼吸支持治疗是急性呼吸窘迫综合征治疗中重要的环节,循证医学已经证明肺保护性通气能改善患者预后,但随着急性呼吸窘迫综合征病因愈加多样,病理生理和临床表现越为复杂,对小潮气量通气实施、体外膜氧合、镇静镇痛控制呼吸驱动以及俯卧位通气的指征和实施提出了新的挑战。Acute respiratory distress syndrome(ARDS)is a series of phenotypes caused by the interaction of different genetic backgrounds,environmental factors,and host factors.It has significant heterogeneity in etiology,pathophysiology,pathological manifestations and clinical characteristics.The heterogeneity also brings many difficulties to treatment.Individualized and precise treatments of ARDS based on phenotypes such as inflammatory response,pathophysiological characteristics,imaging findings and omics differences may be the future treatment direction.Respiratory support therapy is an important part of ARDS treatment.Evidence-based medicine has proven that lung protective ventilation can improve the prognosis of the patients.However,as the causes of ARDS become more diverse,the pathophysiology and clinical manifestations become more complex and the indications and implementation of low tidal volume ventilation,extra-corporeal membrane oxygenation(ECMO),sedative and analgesic respiratory drive control and prone position ventilation have faced the new challenges.

关 键 词：急性呼吸窘迫综合征 肺保护性通气 呼吸机相关肺损伤 自戕性肺损伤 俯卧位通气 

分 类 号：R563.8[医药卫生—呼吸系统]