慢性酗酒与急性肺损伤/急性呼吸窘迫综合征

急性肺损伤/急性呼吸窘迫综合征(acute lung injury/accute respiratory distress syndrome,ALI/ARDS)是在非心源性疾病过程中.     

硫辛酸对急性肺损伤保护作用

目的：探讨代谢性抗氧化剂硫辛酸(LA)对内毒素(LPS)诱发大鼠急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)模型的保护机制,为急性肺损伤的治疗提供新的思路和方法。方法将ALI/ARDS大鼠分为正常对照组(生理盐水(NS)组)、ALI/ARDS模型组(脂多糖(LPS组)、LA干预组(LA组)和谷胱甘肽干预组(GSH组),每组各10只。注射后1、2、4和6h观察血清肿瘤坏死因子(TNF-A)水平,6 h后处死大鼠,测定动脉血氧分压(PaO2)、血清脂过氧化物水平(LPO)、肺湿干比(W/D)、肺泡灌洗液(BALF)中蛋白浓度和TNF-水平。结果LA组和GSH组PaO2水平较LPS组明显增高(<0.05);血清LPO水平、W/D、BALF中蛋白浓度明显下降(<0.05);LA组TNF-水平呈进行性下降,在注射后各时点与LPS组比较均明显降低(<0.05)。结论 LA对LPS诱发的大鼠ALI/ARDS模型的损伤有一定保护作用。     

急性肺损伤/急性呼吸窘迫综合征相关微RNA研究进展

微RNA(miRNA)是一组高度保守的长度约22个核苷酸的非编码RNA,通过靶定相应的互补序列导致mRNA的沉默或者抑制翻译以调节基因和蛋白的表达。急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的发病机制错综复杂,涉及失控性炎症反应、细胞凋亡及肺泡液体清除异常等多个层面,而且各个层面相互影响形成复杂的细胞网络和细胞因子网络,其通过不同的信号转导通路调控机体炎症反应。ALI发病过程中miRNA表达异常,miRNA可通过与靶mRNA部分结合在转录和转录后水平调节靶基因表达,参与ALI的整个发病过程。本文总结了国内外ALI发病过程中相关miRNA的研究进展,旨在寻找和验证miRNA在ALI炎症激活和信号转导途径中的作用,为ALI的诊疗提供新靶点。     

51例不明原因重症肺炎导致急性肺损伤的护理

总结了51例不明原因重症肺炎导致急性肺损伤的护理。严密监测生命体征,有效维持患者呼吸氧合,早期规范使用激素及加强对呼吸机相关性肺炎的预防。经积极治疗和精心护理,本组36例好转出院,15例死亡。     

肺血管内皮细胞分泌功能的改变与急性肺损伤/急性呼吸窘迫综合征

急性肺损伤(acute lung injury,ALI)/急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)是临床上常见的急危重症,病死率高达25%~45%,治疗上主要限于器官功能与全身支持治疗,尤其是呼吸支持治疗,“等待”肺损伤的缓解。在ARDS发病机制中肺血管内皮细胞(pulmonary vascular endothelial cell,PVEC)既是受损的主要靶细胞,更是活跃的炎症和效应细胞,血管内皮细胞(vascular endothelial cell,VEC)的激活和损伤程度与ARDS预后密切相关。本文将主要阐述ALI/ARDS发病机制中PVEC部分分泌功能的改变。     

急性肺损伤／急性呼吸窘迫综合征的生物疗法

急性肺损伤／急性呼吸窘迫综合征是临床常见的急危重症,目前仍缺乏有效的药物干预措施。本文归纳了近年来极具临床应用潜力的、包括抗炎治疗、生长因子治疗、凝血因子治疗、干细胞治疗、基因治疗等在内的生物疗法以供临床治疗和科研参考。     

急诊肺炎患者发生急性肺损伤/急性呼吸窘迫综合征危险因素分析

目的探讨急诊肺炎患者发生急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的早期危险因素。方法回顾性分析中国医科大学附属第一医院急诊科收治的100例肺炎患者,其中男性62例,女性38例;年龄49~79岁,平均年龄62岁。观察72h,发展至ALI/ARDS为ALI/ARDS组,未发展至ALI/ARDS的分为单纯肺炎组。收集两组患者的年龄、性别、生命体征、初始所需吸氧浓度及初诊的实验室检查(白细胞、血小板计数、血清白蛋白、尿素氮、丙氨酸氨基转移酶)指标,对各项因素进行单因素分析,单因素分析有显著意义的变量行二项分类的Logistic回归分析。结果 100例患者35例发展为ALI/ARDS,65例未发展为ALI/ARDS。单因素分析结果显示,患者是否发展为ALI/ARDS与年龄、性别、体温、呼吸频率、休克、白细胞计数、尿素氮等比较,差异无统计学意义(P0.05);初始所需吸氧浓度(维持血氧饱和度≥90%)、改良后的快速急诊内科评分(REMS)、低蛋白血症与发展为ALI/ARDS差异有统计学意义(P0.05)。二项分类的Logistic回归分析显示,仅吸氧浓度、改良后的REMS评分是发展为ALI/ARDS的独立危险因素。其中吸氧浓度2 L/min的灵敏度为77.1%,特异度为86.2%;改良后的REMS≥7发生ALI/ARDS灵敏度为74.3%,特异度为72.3%。结论初始吸氧浓度及改良后的REMS评分与ALI/ARDS的发生存在正相关,初始吸氧浓度2 L/min和/或改良后的REMS≥7的肺炎患者应予以重视,是ALI/ARDS的高危患者,争取做到早期诊治。     

降钙素基因相关肽对急性肺损伤兔血浆一氧化氮的影响

AIM:To examine whether calcitonin gene-related peptide (CGRP) enhances nitric oxide (NO) level in pulmonary circulation blood and observe the influence of CGRP on mean pulmonary artery pressure (mPAP) in rabbits with acute lung injury (ALI) caused by oleic acid.METHODS: The level of NO was assessed by measuring the presence of nitrite in cervical artery blood by the Griess reaction, mPAP was measured with right ventricular catheter.RESULTS:The level of nitrite in cervical artery blood was significantly increased and the mPAP was markedly reduced after administration of CGRP intravenousely.CONCLUSION:CGRP enhanced the NO level of pulmonary circulation blood and reduces the mPAP significantly in rabbits with ALI.     

模式识别受体PRRs在急性肺损伤/急性呼吸窘迫综合征发病机制中的作用研究进展

急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)是继发于肺内或全身的炎症反应过程,它由肺泡损伤导致并形成炎症性非心源性的肺水肿.模式识别受体(PRRs)参与先天免疫系统的激活,PRRs可以启动炎症信号级联反应,并释放促炎细胞因子.本综述对PRRs所包括的跨膜受体TLRs、胞质受体RLRs和NLRs以及下游炎症通路N...     

急性肺损伤/急性呼吸窘迫综合征与NF-κB信号转导关系的研究进展

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是临床上最常见的急危重症,其发病机制错综复杂,缺乏主动性治疗措施,病死率高。研究表明,核因子κB(NF-κB)为一种诱导型核转录因子,在ALI/ARDS发展过程中发挥极为广泛的功能,并与炎症反应具有密切的关系。现就ALI/ARDS、NF-κB信号转导通路及两者的关系作一简要的论述。     

Predictive Role of Lung Injury Prediction Score in the Development of Acute Respiratory Distress Syndrome in Korea

PurposeEarly recognition and therapeutic intervention are important in patients at high risk of acute respiratory distress syndrome (ARDS). The lung injury prediction score (LIPS) has been used to predict ARDS development; however, it was developed based on the previous definition of ARDS. We investigated the predictive role of LIPS in ARDS development according to its Berlin definition in the Korean population.Materials and MethodsThis was a retrospective study that enrolled adult patients admitted to the intensive care unit (ICU) at a single university-affiliated hospital in Korea from September 1, 2018, to August 31, 2019. LIPS at the time of ICU admission and the development of ARDS were evaluated.ResultsOf the 548 enrolled patients, 33 (6.0%) fulfilled the Berlin ARDS definition. The LIPS for non-ARDS and ARDS groups were 4.96±3.05 and 8.53±2.45, respectively (p<0.001); it was significantly associated with ARDS development (odds ratio 1.48, 95% confidence interval, 1.29–1.69; p<0.001). LIPS >6 predicted the development of ARDS with a sensitivity of 84.8% and a specificity of 67.2% [area under the curve (AUC)=0.82]. A modified LIPS model adjusted for age and severity at ICU admission predicted ICU mortality in patients with ARDS (AUC=0.80), but not in those without ARDS (AUC=0.54).ConclusionLIPS predicted the development of ARDS as diagnosed by the Berlin definition in the Korean population. LIPS provides useful information for managing patients with ARDS.     

CALIPSO: A Randomized Controlled Trial of Calfactant for Acute Lung Injury in Pediatric Stem Cell and Oncology Patients

To assess if calfactant reduces mortality among children with leukemia/lymphoma or after hematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS), we conducted a multicenter, randomized, placebo-controlled, double-blinded trial in 17 pediatric intensive care units (PICUs) of tertiary care children's hospitals. Patients ages 18 months to 25 years with leukemia/lymphoma or having undergone HCT who required invasive mechanical ventilation for bilateral lung disease with an oxygenation index (OI) > 10 and <37 were studied. Interventions used were intratracheal instillation of either calfactant or air placebo (1 or 2 doses). Forty-three subjects were enrolled between November 2010 and June 2015: 26 assigned to calfactant and 17 to placebo. There were no significant differences in the primary outcome, which was survival to PICU discharge (adjusted hazard ratio of mortality for calfactant versus placebo, 1.78; 95% confidence interval, .53 to 6.05; P?=?.35), OI, functional outcomes, or ventilator-free days, adjusting for risk strata and Pediatric Risk of Mortality (PRISM) score. Despite the risk-stratified randomization, more allogeneic HCT patients received calfactant (76% and 39%, respectively) due to low recruitment at various sites. This imbalance is important because independent of treatment arm and while adjusting for PRISM score, those with allogeneic HCT had a nonsignificant higher likelihood of death at PICU discharge (adjusted odds ratio, 3.02; 95% confidence interval, .76 to 12.06; P?=?.12). Overall, 86% of the patients who survived to PICU discharge also were successfully discharged from the hospital. These data do not support the use of calfactant among this high mortality group of pediatric leukemia/lymphoma and/or HCT patients with PARDS to increase survival. In spite of poor enrollment, allogeneic HCT patients with PARDS appeared to be characterized by higher mortality than even other high-risk immunosuppressed groups. Conducting research among these children is challenging but necessary, because survival to PICU discharge usually results in successful discharge to home.     

Acute respiratory distress syndrome: Pulmonary and extrapulmonary not so similar

Acute respiratory distress syndrome (ARDS) is characterized by acute onset respiratory failure with bilateral pulmonary infiltrates and hypoxemia. Current evidence suggests different respiratory mechanics in pulmonary ARDS (ARDSp) and extrapulmonary ARDS (ARDSexp) with disproportionate decrease in lung compliance in the former and chest wall compliance in the latter. Herein, we report two patients of ARDS, one each with ARDSp and ARDSexp that were managed using real-time esophageal pressure monitoring using the AVEA ventilator to tailor the ventilatory strategy.     

Alveolar recruitment maneuvers in acute lung injury/acute respiratory distress syndrome

Mechanical ventilation can worsen lung damage in acute lung injury and acute respiratory distress syndrome. The use of low tidal volumes is one of the strategies that has been shown to reduce lung injury and improve outcomes in this situation. However, low tidal volumes may lead to alveolar derecruitment and worsening of hypoxia. Recruitment maneuvers along with positive end-expiratory pressure may help to prevent derecruitment. Although recruitment maneuvers have been shown to improve oxygenation, improved clinical outcomes have not been demonstrated. The optimal recruitment strategy and the type of patients who might benefit are also unclear. This review summarizes the impact of recruitment maneuvers on lung mechanics and physiology, techniques of application, and the clinical situations in which they may be useful.     

Incidence and outcome of acute lung injury and acute respiratory distress syndrome in the surgical intensive care unit

Introduction:

To determine the incidence and mortality of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in a cohort of patients with risk factors admitted to the Surgical Intensive Care Unit (SICU).

Materials and Methods:

A prospective observational inception cohort study with no intervention was conducted over 12 months. All patients with at least one known risk factor for ALI/ARDS admitted to the SICU were included in the study. The APACHE II severity of disease classification system scoring was performed within 1 h of admission. The ventilatory parameters and chest radiographs were recorded every 24 h. The P/F ratio, PEEP and Lung Injury Score were calculated each day until the day of discharge from the Intensive Care Unit or for the first 7 days of admission, whichever was shorter.

Results:

The incidence of ARDS among those who were mechanically ventilated was 11.4%. Sepsis was the most common (34.6%) etiology. Among those with risk factors, the incidence of ARDS was 30% and that of ALI was 32.7%. The mortality in those with ARDS was 41.8%. Those who develop ARDS had higher APACHE II scores, lower pH and higher PaCO₂ at admission compared with those who developed ALI or no lung injury.

Conclusion:

The incidence and mortality of ARDS was similar to other studies. Identifying those with risk factors for ARDS or mortality will enable appropriate interventional measures.     

内毒素“二次打击”顽固性低氧血症大鼠ARDS模型建立与评价

目的：研究经内毒素“一次打击”和“二次打击”后致急性肺损伤(ALI)大鼠,建立稳定和可靠的急性呼吸窘迫综合征（ARDS）动物模型,并探讨其意义和理论依据。方法:大肠杆菌脂多糖(LPS)较大剂量（10mg/kg）静脉注射或气管滴入致伤大鼠,复制“一次打击”ARDS模型;LPS小剂量（1mg/kg）腹腔注射致伤大鼠后,再予中等剂量LPS（5mg/kg）气管滴入,建立“二次打击”ARDS模型。连续3d动脉血气分析,结合肺湿重/干重比值(W／D)及肺组织病理观察,评价3种ALI/ARDS模型异同。测定血浆与支气管肺泡灌洗液（BALF）中TNF-α、IL-1、IL-10水平,探讨LPS二次打击法可能致病机制。结果:(1)单次LPS打击（无论是静脉注射或气管滴入）仅引发大鼠ALI和一过性低氧血症,LPS二次打击法可以引发大鼠更为持久的低氧血症和特异性肺损伤,是较为理想的ARDS的动物模型。(2)LPS二次打击法引发的ARDS发病机制与全身失控性炎症反应与肺的特异性损伤有关。结论:LPS二次打击法可建立更为稳定可靠的符合诊断指标的大鼠ARDS模型,并能更好地反映肺损伤的病理变化。     

不同呼吸支持模式对重症肺炎所致急性呼吸窘迫综合症患者预后的影响

目的 探讨不同呼吸支持模式对重症肺炎所致急性呼吸窘迫综合征（ARDS）患者病死率的影响。方法 收集2014年1月1日~2017年10月31日于我院ICU住院的2852例患者信息,根据ARDS的柏林定义对患者进行筛查,纳入ARDS患者615例,再选择重症肺炎所致的ARDS患者109例进入研究,运用统计学方法对患者一般信息、临床结局、治疗费用等进行分析,比较不同呼吸支持模式对重症肺炎所致ARDS患者生存率的影响。结果 死亡组与生存组性别、年龄、ICU住院日、抗生素费用、住院总费用比较,差异无统计学意义（P＞0.05）,不同呼吸支持模式比较,差异有统计学意义（P＜0.05）;多因素分析结果显示,不同呼吸支持模式是患者临床结局（死亡）的独立危险因素（P＜0.05）;病程早期无机械通气组患者生存率最高,高机械通气条件患者生存率优于低机械通气及无创通气条件患者,低机械通气条件患者生存率最差,病程后期无机械通气组患者生存率最高,无创机械通气组患者生存率高于低机械通气组及高机械通气组患者。结论 规范使用不同呼吸支持模式治疗重症肺炎所致ARDS可能改善患者预后,临床应用可行性高。