《2023年美国胸科学会关于成人急性呼吸窘迫综合征患者管理的临床实践指南更新》解读  

Interpretation of an update on clinical practice guideline of adult patients with acute respiratory distress syndrome of American Thoracic Society

作　　者：王晓霞 乌丹 张江英 乌雅罕 郝颖楠 斯日古楞 Wang Xiaoxia;Wu Dan;Zhang Jiangying;Wu Yahan;Hao Yingnan;Siriguleng(Department of Intensive Care Unit,Inner Mongolia Autonomous Region People’s Hospital,Hohhot 010017,China;Department of Pharmacy,Inner Mongolia Autonomous Region People’s Hospital,Hohhot 010017,China)

机构地区：[1]内蒙古自治区人民医院重症医学科,呼和浩特010017 [2]内蒙古自治区人民医院药学处,呼和浩特010017

出　　处：《中华重症医学电子杂志》2024年第4期338-343,共6页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：内蒙古医科大学联合项目(YHD2023LH076);内蒙古自治区卫生健康科技计划项目(2023GLLH047)

摘　　要：急性呼吸窘迫综合征(ARDS)是一种非心源性肺水肿,致死率极高。随着新型冠状病毒感染(COVID-19)的大流行,ARDS的诊断和治疗重新引起临床的重视。美国胸科学会(ATS)2023年依据更新的循证证据对ARDS的治疗策略提出指导意见,内容涉及ARDS患者皮质类固醇的使用、体外膜肺氧合(ECMO)的选择、神经肌肉阻滞剂的应用及呼气末正压(PEEP)的使用四个部分。该指南建议ARDS患者使用皮质类固醇;建议对选定的严重ARDS患者进行静脉-静脉体外膜肺氧合(VV-ECMO);建议早期重症ARDS患者使用神经肌肉阻滞剂;建议中-重度ARDS患者,在不进行肺复张操作的情况下使用较高的PEEP而非较低PEEP;反对对中-重度ARDS患者使用长时间的肺复张操作。该文就相关内容作简要解读,以期为临床ARDS患者诊疗提供参考。Acute respiratory distress syndrome(ARDS)is a type of non-cardiogenic pulmonary edema with a high mortality rate.With the pandemic of novel coronavirus infection(COVID-19),the diagnosis and treatment of ARDS have attracted renewed attention in clinical practice.Based on the updated evidence-based research,the American Thoracic Society issued guidelines for the treatment of ARDS in 2023,involving four parts:the use of corticosteroids,the selection of extracorporeal membrane oxygenation(ECMO),the application of neuromuscular blocking agents,and the use of positive end-expiratory pressure(PEEP)in ARDS patients.The guidelines recommends corticosteroids for patients with ARDS.Venovenous extracorporeal membrane oxygenation(V-V ECMO)is recommended for selected patients with severe ARDS.Neuromuscular blockers are recommended for patients with early severe ARDS.For patients with moderate-to-severe ARDS,a higher PEEP is recommended over a lower PEEP without lung recruitment maneuvers(LRMs).Prolonged lung recruitment maneuvers are not recommended for patients with moderate-to-severe ARDS.This article briefly interprets the relevant content in order to provide clinical references for the diagnosis and treatment of ARDS patients.

关 键 词：急性呼吸窘迫综合征 皮质类固醇 体外膜肺氧合 神经肌肉阻滞剂 呼气末正压 

分 类 号：R563.8[医药卫生—呼吸系统]