急性肺损伤和急性呼吸窘迫综合征的支持治疗

急性呼吸窘迫综合征（ＡＲＤＳ）至今仍缺乏有效治疗,与其相关的病死率仍在５０％以上〔１〕。目前治疗ＡＲＤＳ及急性肺损伤（ＡＬＩ）的一般原则包括：治疗导致ＡＲＤＳ和ＡＬＩ的基础疾病,排除感染因素（所有ＡＬＩ和ＡＲＤＳ的患者,都应该怀疑有感染）,除外弥散性肺炎（一般要求用支气管镜、支气管肺泡灌洗、经支气管肺活检３种方法排除）,支持治疗（包括机械通气、体位治疗、血流动力学管理、血管活性药物的应用、实验性药物治疗、继发性并发症的防治等）。其中支持治疗仍是治疗的关键和重点。本文就有关ＡＬＩ和ＡＲＤＳ的支持治…     

急性肺损伤早期抗凝疗法的研究

采用骨髓提取液静脉注射建立家兔急性肺损伤的动物模型。实验组在实验过程中使用肝素进行抗凝治疗，对照组不进行抗凝治疗。两组动物同时观察生命体征，血液气体分析，Ｘ线胸片，及肺病理学检查，分析早期抗凝疗法对急性肺损伤以及由此继发的全身脏器损害的影响。     

急性肺损伤/急性呼吸窘迫综合征诊治进展

急性肺损伤(acute lung injury,ALI)和急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是指由心源性以外的各种肺内外致病因素导致的急性、进行性缺氧性呼吸衰竭。Ashbough于1967年报道ARDS时,他所指的ARDS的"A"字意指Adult,即成人[1],其实ALI/ARDS是一种常见危     

无创正压通气治疗急性肺损伤/急性呼吸窘迫综合征的观察

目的 评价无创正压通气(NPPV)治疗急性肺损伤(ALI)／急性呼吸窘迫综合征(ARDS)患者的临床效果。方法 对18例ALI/ARDS患者实施NPPV治疗结果进行回顾性总结，分析NPPV治疗前后动脉血氧分压／吸氧浓度(PaO2／FiO2)、呼吸频率(RR)和心率(HR)的变化。结果 NPPV治疗成功率为55.6％(10／18)，8例NPPV治疗失败患者中7例改用气管插管有创通气。总死亡率为33．3％(6／18)。NPPV成功组50％(5／10)为ALI患者，治疗后1～2h PaO2／FiO2、RR和HR较治疗前有显著改善。NPPV失败组均为ARDS患者，治疗后1-2h PaO2／FiO2、RR和HR无明显变化。结论 NPPV对部分ALI／ARDS患者是有效的支持治疗手段，尤其是ARDS早期的ALI阶段可考虑选用NPPV。如NPPV治疗失败，应及时转换为气管插管有创通气。     

急性肺损伤和急性呼吸窘迫综合征临床流行病学研究进展

急性肺损伤 (ａｃｕｔｅｌｕｎｇｉｎｊｕｒｙ,ＡＬＩ)和急性呼吸窘迫综合征 (ａｃｕｔｅｒｅｓｐｉｒａｔｏｒｙｄｉｓｔｒｅｓｓｓｙｎｄｒｏｍｅ ,ＡＲＤＳ)是临床较为多见的危重症 ,196 7年Ａｓｈｂａｕｇｈ等〔1〕首次报道ＡＲＤＳ12例病例以来 ,对其发病机制、诊断治疗和临床流行病学调查都有了较大的进展。 1994年美欧联合发表ＡＬＩ和ＡＲＤＳ的新定义〔2〕,认为ＡＬＩ ＡＲＤＳ是由心源性以外的各种肺内外致病因素导致的急性、进行缺氧性呼吸衰竭 ,ＡＬＩ ＡＲＤＳ的病理基础是由多种炎性细胞介导的肺脏局部炎症反应和炎症反应失控…     

急性肺损伤及急性呼吸窘迫综合征的护理进展

综述了急性肺损伤及急性呼吸窘迫综合征的病因以及保护性通气、呼吸机肺炎的预防措施和临床护理路径的实施.     

急性肺损伤及急性呼吸窘迫综合征的护理进展

综述了急性肺损伤及急性呼吸窘迫综合征的病因以及保护性通气、呼吸机肺炎的预防措施和临床护理路径的实施。     

氯氮平中毒继发急性肺损伤/急性呼吸窘迫综合征的抢救体会

目的:探讨氯氮平中毒继发急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)有效的治疗方法。方法:总结分析16例氯氮平中毒继发ALI/ARDS患者的临床表现和治疗方法。患者在中毒后6～144h出现ALI/ARDS表现,予气管插管、机械通气,抗胆碱药物治疗及血液灌流等综合治疗。结果:本组患者均治愈,平均住院时间(14±1.6)d;机械通气时间平均(134±12)h,中毒后(48～96)h意识转清。结论:氯氮平中毒继发的急性肺损伤/急性呼吸窘迫综合征主要与肺水肿、吸入性肺炎及氯氮平对肺组织的直接损伤作用有关。早期进行机械通气联合血液灌流和合理抗胆碱药物的,是治疗重度氯氮平重度并发急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的有效方法。     

急性肺损伤/急性呼吸窘迫综合征的困惑与思考

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的认识和治疗虽然已经取得长足的进展,但目前对ALI/ARDS的诊断及治疗仍有较多的困惑,值得思考.诊断方面虽有诊断标准,但仍待改进.治疗方面也存在争议: ①保护性通气策略中潮气量与平台压,哪项更为重要?②最佳呼气末正压(PEEP)的选择,争论已久,尚无定论?③肺复张是否真正有效?④肺水管理:限制性液体策略还是开放性液体策略?     

重症胸部外伤致急性肺损伤和急性呼吸窘迫综合征的临床治疗

随着社会交通和建筑事业的发展,胸外伤的发生率呈上升的趋势.由于胸腔特殊的解剖和生理特点,临床上以闭合性损伤较为多见,开放性损伤少见.胸外伤轻者只有胸壁软组织挫伤或(和)单纯肋骨骨折,重伤者多伴有肺脏挫裂伤、心脏及大血管损伤,或合并颅脑、腹腔脏器和脊柱四肢骨骼损伤,病情危重.如果导致气胸、血胸、心包腔内出血、急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS),易引起呼吸及循环功能紊乱,有生命危险,死亡率较高,及时有效的诊疗措施是救治成功的关键.     

Surfactant therapy for acute lung injury/acute respiratory distress syndrome

PURPOSE OF REVIEW: Currently, three phase III surfactant replacement trials for acute lung injury (ALI)/acute respiratory distress syndromes (ARDS) patients are underway. Although the efficacy of surfactant replacement therapy will first have to be proved in these phase III trials, recent reports indicate some enticing possibilities for the future of surfactant therapy. RECENT FINDINGS: Patients requiring mechanical ventilation show alterations in their endogenous surfactant composition. Depending on the type of lung injury or the elapsed time, modifications to surfactant preparations could enhance the efficacy of these preparations. Surfactants that closely resemble natural surfactant, especially those containing surfactant proteins (SP-B/C) and nonphospholipids (cholesterol), are able to restore normal surfactant physiology. Furthermore, lipids that are able to withstand degradation by lipases could further enhance surfactant therapy. SUMMARY: If surfactant therapy fulfills the promises expected from the ongoing phase III trials, future surfactant preparations may even enhance therapy efficacy and restore the altered endogenous surfactant pool as soon as possible.     

Surfactant therapy in adults with acute lung injury/acute respiratory distress syndrome

PURPOSE OF REVIEW: Several phase II and phase III studies have been performed to investigate safety, efficacy and the improvement of survival due to exogenous surfactant instillation in patients with acute lung injury or acute respiratory distress syndrome. In this review we will discuss the most recent of these studies, paying particular attention to differences in the composition of the exogenous surfactant used, the diverse modes of delivery and dose of therapy and the influence of mechanical ventilation. RECENT FINDINGS: Several phase II studies performed on patients with acute lung injury or acute respiratory distress syndrome and a phase III study performed on a pediatric population have shown beneficial effects of surfactant on oxygenation and survival. No effect of exogenous surfactant has been shown on survival in phase III studies in adult patients. SUMMARY: The changes in the surfactant system of patients with acute lung injury and acute respiratory distress syndrome form the rationale for the instillation of exogenous surfactant. There is enough evidence to use surfactant instillation for pediatric patients with acute lung injury. Due to the results of the randomized controlled trials performed so far, however, exogenous surfactant is not recommended for routine use in patients with acute lung injury or acute respiratory distress syndrome. In the future, other surfactants with different compositions may show beneficial effects.     

Surfactant therapy for acute lung injury and acute respiratory distress syndrome

This article examines exogenous lung surfactant replacement therapy and its usefulness in mitigating clinical acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Surfactant therapy is beneficial in term infants with pneumonia and meconium aspiration lung injury, and in children up to age 21 years with direct pulmonary forms of ALI/ARDS. However, extension of exogenous surfactant therapy to adults with respiratory failure and clinical ALI/ARDS remains a challenge. This article reviews clinical studies of surfactant therapy in pediatric and adult patients with ALI/ARDS, focusing on its potential advantages in patients with direct pulmonary forms of these syndromes.     

Peripheral airways injury in acute lung injury/acute respiratory distress syndrome

PURPOSE OF REVIEW: Peripheral airways are less than 2 mm in diameter and comprise a relatively large cross-sectional area, which allows for slower, laminar airflow. They include both membranous bronchioles and gas exchange ducts, and have been referred to in the past as the 'quiet zone', partly because these structures were felt to contribute little to lung mechanics, and partly because they are difficult to study directly. RECENT FINDINGS: Recent studies suggest that peripheral airway dysfunction plays a significant role in acute respiratory distress syndrome, which may be exacerbated by injurious mechanical ventilation strategies. The presence of elevated airways resistance, intrinsic positive end-expiratory pressure or a lower inflection point on a pressure-volume curve of the respiratory system may indicate presence of impaired peripheral airway function. In-vitro animal and human studies have begun to elucidate the signaling mechanisms responsible for stretch and shear mediated cellular injury. SUMMARY: Understanding the pathophysiology of peripheral airway dysfunction in acute respiratory distress syndrome and mechanical ventilation continues to evolve. Greater insight into the signaling mechanisms involved in cellular injury and repair will lead to further alterations in mechanical ventilation strategies, and may lead to specific treatment options.     

The endothelium in acute lung injury/acute respiratory distress syndrome

PURPOSE OF REVIEW: Since pulmonary edema from increased endothelial permeability is the hallmark of acute lung injury, a frequently encountered entity in critical care medicine, the study of endothelial responses in this setting is crucial to the development of effective endothelial-targeted treatments. RECENT FINDINGS: From the enormous amount of research in the field of endothelial pathophysiology, we have focused on work delineating endothelial alterations elicited by noxious stimuli implicated in acute lung injury. The bulk of the material covered deals with molecular and cellular aspects of the pathogenesis, reflecting current trends in the published literature. We initially discuss pathways of endothelial dysfunction in acute lung injury and then cover the mechanisms of endothelial protection. Several experimental treatments in animal models are presented, which aid in the understanding of the disease pathogenesis and provide evidence for potentially useful therapies. SUMMARY: Mechanistic studies have delivered several interventions, which are effective in preventing and treating experimental acute lung injury and have thus provided objectives for translational studies. Some of these modalities may evolve into clinically useful tools in the treatment of this devastating illness.     

The epithelium in acute lung injury/acute respiratory distress syndrome

PURPOSE OF REVIEW: The mechanisms of epithelial injury in acute lung injury/acute respiratory distress syndrome have been of interest since the syndrome was first described. Cell therapies to replace injured epithelium are a futuristic dream; however, there is ongoing research to achieve this goal. We review research regarding the function of the epithelium in acute lung injury/acute respiratory distress syndrome, including potential novel therapies. RELEVANT FINDINGS: Altered fluid clearance from the injured lungs in acute lung injury/acute respiratory distress syndrome patients has been consistently found and is an important prognostic finding. New research suggests that neutrophils that enter the lung late and which are enticed into the lung through a specific chemokine system may be important for causing lung injury. If this is the case, then blockers of this system could be a possible therapy. The role of fibrinolysis and coagulation abnormalities in lung injury due to infection and other perturbations is examined. These abnormal findings may be useful diagnostic tools for prognostication as well as targets for future therapies. SUMMARY: Epithelial damage is a hallmark of acute lung injury/acute respiratory distress syndrome. An increased understanding of the function of these cells and of the abnormalities that occur when these lung cells are injured should allow the development of novel therapies and, perhaps, lead to replacement therapies.     

Acute lung injury and the acute respiratory distress syndrome

Although ALI/ARDS mortality rates have improved over the last several decades, they remain high, particularly in the geriatric patient population. Although considerable progress has been made in understanding the pathogenesis of the disease, a large number of promising treatments have proven unsuccessful. One exception has been in the area of ventilator management, where a strategy of protective ventilation with low tidal volumes has demonstrated a significant mortality benefit. Basic research continues to help advance our understanding of this complex syndrome and identify interesting new directions of investigation. The results of several large, randomized trials of new ventilatory and pharmacologic strategies currently underway may help identify successful methods of treating this important disease.