中性粒细胞胞外诱捕网介导急性呼吸窘迫综合征患者肺损伤机制及对策

在急性呼吸窘迫综合征（ARDS）发生发展的过程中,中性粒细胞可产生包含多种生物活性物质的中性粒细胞胞外诱捕网（NETs）。过度产生的NETs可通过水解蛋白及诱导炎症反应、影响肺泡巨噬细胞功能、激活凝血等机制导致肺组织损伤。针对NETs的形成途径及作用机制进行调节,可作为ARDS的治疗靶点。本文对NETs在ARDS中造成...     

NETs在急性呼吸窘迫综合征新生儿中的变化及意义

目的 观察急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)新生儿中是否存在中性粒细胞胞外诱捕网(neutrophil extracellular traps, NETs)的形成,以及动态观察血浆游离DNA(cell-free DNA, cf-DNA)/NETs的变化在ARDS严重程度及治疗效果中的意义。方法 前瞻性选取2020年10月～2022年4月在江苏大学附属医院收治的需呼吸机辅助通气的37例ARDS新生儿为ARDS组,根据氧合指数(oxygenation index, OI)分为轻度ARDS组(4≤OI<8)、中度ARDS组(8≤OI<16)及重度ARDS组(OI≥16);以同期分娩的27例正常新生儿为对照组。采用荧光酶标仪检测cf-DNA的含量;酶联免疫吸附试验(enzyme linked immunosorbent assay, ELISA)分别检测NETs成分中性粒细胞弹性蛋白酶(neutrophil elastase, NE)的含量及肿瘤坏死因子(tumor necrosis factor-α, TNF-...     

炎症—抗炎症反应失衡在急性呼吸窘迫综合征发病中的作用

急性呼吸窘迫综合征（ａｃｕｔｅｒｅｓｐｉｒａｔｏｒｙｄｉｓｔｒｅｓｓｓｙｎｄｒｏｍｅ，ＡＲＤＳ）是多种疾病引起的急性呼吸衰竭。其病情凶险，早期诊断困难，无特效治疗方法，病死率高达５０％～７０％。ＡＲＤＳ发病机制错综复杂，近几年对此问题的研究虽有所进展，但仍未完全阐明。纵观这些研究，多侧重于某一个方面进行探索，如氧自由基的大量释放、花生四烯酸的代谢产物增加、表面活性物质的减少等。但总的来看，这些都是炎症反应过度的结果，即ＡＲＤＳ的形成与机体炎症反应与抗炎症反应失衡有关，下面就此进行讨论。一、炎症…     

全身炎症反应综合征、急性肺损伤与急性呼吸窘迫综合征

196 7年Ａｓｈｂａｕｇｈ等报道成人呼吸窘迫综合征 (ＡＲＤＳ )以来 ,国内外学者就ＡＲＤＳ进行了大量临床与试验研究工作。但ＡＲＤＳ的发病机制错综复杂 ,迄今尚未完全阐明。 70年代将损伤后的过程理解为 :损伤→感染→脓毒症→多器官衰竭 (ＭＯＦ)。随着失控的炎症反应引发     

microRNA在急性肺损伤/急性呼吸窘迫综合征中的研究进展

急性呼吸窘迫综合征(ARDS)是一种以炎症、肺通透性和水肿为特征的破坏性免疫反应,可导致肺上皮和内皮细胞发生危及生命的急性损伤(ALI)。微小RNA(microRNA,miRNA)是一类能够调控基因表达的分子,参与调节许多生物学过程。miRNA在生物学过程中的发育、增殖和细胞凋亡等方面发挥着重要作用。本文对miRNA与肺损伤以及ARDS预后的关系进行综述。     

重型颅脑损伤伴急性呼吸窘迫综合征27例

<正> 急性呼吸窘迫综合征(ARDS)是以急性呼吸窘迫和低氧血症为主要表现的急性呼吸衰竭疾病。重型颅脑损伤并发ARDS后,病情发展快,如诊治不当或不及时,常会失去抢救时机而致病人死亡,死亡率高达50～70％。本文就笔者1995年以来先后救治的27例重型颅脑损伤伴急性呼吸窘迫综合征分析报告如下。     

肠外深静脉营养在急性呼吸窘迫综合征中的应用及护理

急性呼吸窘迫综合征（ＡＲＤＳ）是一种以进行性呼吸困难和顽固性低氧血症为特征的急性呼吸衰竭，治疗上采用纠正缺氧、机械通气和处理基础疾病等综合性治疗，而营养支持及加强护理对预后的影响十分重要。笔者对２４例ＡＲＤＳ患者的临床资料进行分析，结果提示采用肠外深静脉营养（ＴＰＮ）治疗ＡＲＤＳ效果显著，报告如下。１ 临床资料１．１ 一般资料 本组病例２４例，男１４例，女１０例，年龄４２～７０岁，均为我院住院患者。所有病例均符合ＡＲＤＳ诊断标准［１］。治疗上除积极处理原发病等综合性治疗外，均予呼吸机支持呼吸。２４…     

急性呼吸窘迫综合征的新进展

严重急性呼吸综合征(SARS)的暴发流行已经引起全世界医务人员和公众的关注.目前在全球范围已有数千人发病.数百人死亡。此病传染性极强、危害性极大.对人民的生命安全形成严重威胁。而呼吸衰竭和急性呼吸窘迫综合征(ARDS)是SARS病人病情危重和死亡的主要原因.因此.尽管目前SARS在全球范围已得到有效的控制.但SARS或其他呼吸道传染病仍然可能再次袭击人类.因此我们应该更加重视呼吸道感染和肺损伤的研究。目前,尚需深入研究对SARS痛毒的病原学的进一步认识、对SARS病毒致肺损伤的机制的深入探讨.以及对SARS造成严重肺损伤的早期干预,本文简述了近年来急性呼吸窘迫综合征(ARDS)的发病机制及诊治新进展。     

急性呼吸窘迫综合征

急性呼吸窘迫综合征华西医科大学附属第一医院（６１００４１）陈文彬急性呼吸窘迫综合征（ＡＲＤＳ）是由于各种病因引起的肺泡毛细血管膜对液体和溶质的通透性增加，肺血管内与间质之间液体交换障碍，使液体聚积于肺泡和间质间隙，引起肺顺应性降低，功能残气量减少，无...     

细菌感染在急性肺损伤/急性呼吸窘迫综合征中的作用

目的　探讨细菌感染在急性肺损伤 (ALI)和急性呼吸窘迫综合征 (ARDS)发病及进展中的作用。方法　分析10年间发生ALI、ARDS的 60 4例住院患者的临床资料。结果　①导致直接肺损伤的首要原因为肺部感染 ,导致间接肺损伤的首要原因为全身性感染 ;②在所分离的致病菌中 ,革兰阳性球菌 ( 5 0 .76%)和革兰阴性杆菌 ( 4 0 .15 %)基本相等 ,金黄色葡萄球菌和铜绿假单胞菌分别为第一和第二位致病菌 ;③随SIRS分级的提高 ,感染患者ALI和ARDS的发病率均显著增加 (P <0 .0 5 ) ;④随发生功能障碍器官数的增多 ,感染患者ALI的发病率显著增加 (P <0 .0 5 ) ,当发生 2个以上器官 (即 1个肺外器官 )功能障碍时 ,感染患者ARDS病死率显著增加 (P <0 .0 5 ) ;⑤在治疗原发病、氧疗及抗感染基础上的综合治疗可显著提高患者的治愈率 (P <0 .0 5 )。结论　感染是ALI和ARDS发病的主要诱因 ;机会致病菌是导致感染的主要细菌 ;以治疗原发病和抗感染为主的综合治疗可改善二者的预后     

MicroRNA在急性呼吸窘迫综合征中的作用

急性呼吸窘迫综合征(ARDS)是临床常见的危重病症,复杂的炎性反应过程参与了其病理生理过程。小分子非编码的单链RNA的MicroRNA(miRNA)通过影响靶基因的表达调控免疫反应和炎症反应,参与了ARDS的进程。该文综述miRNA在炎症反应和免疫功能障碍以及肺损伤性疾病中的作用,分析了miRNA参与ARDS的炎症反应过程。     

Acute respiratory distress syndrome and acute lung injury

Acute respiratory distress syndrome (ARDS) is a life threatening respiratory failure due to lung injury from a variety of precipitants. Pathologically ARDS is characterised by diffuse alveolar damage, alveolar capillary leakage, and protein rich pulmonary oedema leading to the clinical manifestation of poor lung compliance, severe hypoxaemia, and bilateral infiltrates on chest radiograph. Several aetiological factors associated with the development of ARDS are identified with sepsis, pneumonia, and trauma with multiple transfusions accounting for most cases. Despite the absence of a robust diagnostic definition, extensive epidemiological investigations suggest ARDS remains a significant health burden with substantial morbidity and mortality. Improvements in outcome following ARDS over the past decade are in part due to improved strategies of mechanical ventilation and advanced support of other failing organs. Optimal treatment involves judicious fluid management, protective lung ventilation with low tidal volumes and moderate positive end expiratory pressure, multi-organ support, and treatment where possible of the underlying cause. Moreover, advances in general supportive measures such as appropriate antimicrobial therapy, early enteral nutrition, prophylaxis against venous thromboembolism and gastrointestinal ulceration are likely contributory reasons for the improved outcomes. Although therapies such as corticosteroids, nitric oxide, prostacyclins, exogenous surfactants, ketoconazole and antioxidants have shown promising clinical effects in animal models, these have failed to translate positively in human studies. Most recently, clinical trials with β2 agonists aiding alveolar fluid clearance and immunonutrition with omega-3 fatty acids have also provided disappointing results. Despite these negative studies, mortality seems to be in decline due to advances in overall patient care. Future directions of research are likely to concentrate on identifying potential biomarkers or genetic markers to facilitate diagnosis, with phenotyping of patients to predict outcome and treatment response. Pharmacotherapies remain experimental and recent advances in the modulation of inflammation and novel cellular based therapies, such as mesenchymal stem cells, may reduce lung injury and facilitate repair.     

Rho/Rho激酶信号通路与急性肺损伤/急性呼吸窘迫综合征

Rho/Rho激酶信号通路参与调节细胞的收缩、黏附、迁移、增殖、凋亡等多种生物学行为和功能,随着对Rho/Rho激酶信号通路研究的深入,发现其在急性肺损伤/急性呼吸窘迫综合征中发挥着重要的作用。笔者就Rho/Rho激酶信号通路在急性肺损伤/急性呼吸窘迫综合征中的作用机制作一综述。     

Ventilatory management of acute lung injury and acute respiratory distress syndrome

Context  The acute lung injury and acute respiratory distress syndrome are critical illnesses associated with significant morbidity and mortality. Mechanical ventilation is the cornerstone of supportive therapy. However, despite several important advances, the optimal strategy for ventilation and adjunctive therapies for patients with acute lung injury and acute respiratory distress syndrome is still evolving. Evidence Acquisition  To identify reports of invasive ventilatory and adjunctive therapies in adult patients with acute lung injury and acute respiratory distress syndrome, we performed a systematic English-language literature search of MEDLINE (1966-2005) using the Medical Subject Heading respiratory distress syndrome, adult, and related text words, with emphasis on randomized controlled trials and meta-analyses. EMBASE and the Cochrane Central Register of Controlled Trials were similarly searched. The search yielded 1357 potential articles of which 53 were relevant to the study objectives and considered in this review. Evidence Synthesis  There is strong evidence to support the use of volume- and pressure-limited lung-protective ventilation in adult patients with acute lung injury and acute respiratory distress syndrome. The benefit of increased levels of positive end-expiratory pressure and recruitment maneuvers is uncertain and is being further evaluated in ongoing trials. Existing randomized controlled trials of alternative ventilation modes, such as high-frequency oscillation and adjunctive therapies, including inhaled nitric oxide and prone positioning demonstrate no significant survival advantage. However, they may have a role as rescue therapy for patients with acute respiratory distress syndrome with refractory life-threatening hypoxemia. Conclusions  Volume- and pressure-limited ventilation strategies should be used in managing adult acute lung injury and acute respiratory distress syndrome patients. Further research is needed to identify barriers to widespread adoption of this strategy, as well as the role of alternative ventilation modes and adjunctive therapies.      

小儿急性呼吸窘迫综合征时机械损伤的预防研究

目的:探讨小儿急性呼吸窘迫综合征在治疗时机械损伤的预防。方法:以2009年1月～2011年1月期间本院收治的68例小儿急性呼吸窘迫综合征患者为研究对象,随机分为观察组和对照组,对照组给予常规机械通气方法,观察组给予肺保护性机械通气策略,观察两组患者在呼吸机参数设置、并发症发生率、死亡率、呼吸机使用时间方面的差异。结果:观察组呼吸机参数显著优于对照组,呼吸机相关性肺损伤和脑室内出血的发生率低于对照组,呼吸机应用天数与对照组比较无统计学意义。结论:肺保护性通气策略能够指导急性呼吸窘迫综合征患儿的呼吸机治疗,降低机械通气相关性肺损伤的发生率。     

急性肺损伤/急性呼吸窘迫综合征治疗进展

急性肺损伤/急性呼吸窘迫综合征是临床常见的危重病症之一,起病急、发展快、病死率高,尽管在过去几年中,重症医学的发展使得ARDS的院内发生率和死亡率大幅下降,但目前临床上仍缺乏特效的治疗手段.肺保护通气、积极抗感染治疗和限制性液体管理是目前主要西医治疗策略,近年来有部分改进从而进一步降低该病的死亡率.此外,关于ARDS异...