2009年国家科学技术进步二等奖之呼吸衰竭的发病机制与治疗研究

The second grade national prize for science and technology progress study on pathogenesis and treatment of respiratory failure

针对中国在呼吸衰竭救治方面长期落后的状况,项目系统地对呼吸衰竭发病中的关键环节,治疗呼吸衰竭的关键技术、方法与治疗策略进行研究,作出了重要的科技创新。提出"肺部感染控制窗"的概念,并创立有创-无创序贯通气疗法;提出针对呼吸肌疲劳和呼吸功能不全的无创正压通气(NPPV)治疗新观念;研发并生产出具有自主知识产权的3种新型无创通气面罩;创制具有气道动态萎陷特性的肺模型,证实内源性呼气末正压(PEEPi)导致慢性阻塞性肺疾病(COPD)患者呼吸困难的作用途径;最早在国内建立系统的膈肌肌力和耐力测定方法;证实水通道蛋白1(AQP1,aquaporin1)是肺内液体转运的关键调控点;以前瞻性研究发现抑郁可显著增加COPD急性加重风险;主持制订中国第一部《无创正压通气临床应用中的几点建议》和《AECOPD的机械通气指南》。以多种形式积极推广研究成果,从整体上提高了中国在该领域的治疗与研究水平。

To improve the status of management in respiratory failure in China, the project of Study on Pathogenesis and Treatment of Respiratory Failure was designed and conducted by three medical centers（ Beijing Institute of Respiratory Medicine-Beijing Chaoyang Hospital, Affiliated to Capital Medical University, Zhongshang Hos- pital-Fudan University, Guangzhou Institute of Respiratory Medicine-First Guangzhou Medical College）for more than ten years. This project was focused on pathogenesis and treatment strategies of respiratory failure and achieved the following important innovations： （ 1 ） Pulmonary Infection Control Window （ PIC Window） was firstly proposed and used to determine the time switching point of sequential invasive-noninvasive ventilation; （2） The largest sam- ple size of early use of noninvasive positive pressure ventilation （NPPV） for acute exacerbated COPD （AECOPD） on general ward provided the evidence-based data for expanding the indication of NPPV from treating respiratory failure to alleviating respiratory muscle fatigue ; （3） Three new types of masks with intellectual property for NPPV were developed; （4） Designing of intrinsic expiratory end positive pressure （ PEEPi ） lung model with property of ex- piratory flow limitation confirmed that PEEPi was the most important factor that increased inspiratory difficulty; （5） The systematic measurement was established for diaphragm strength and endurance; （6） Aquaporin 1 （ AQP1 ） was firstly proved the key channel of fluid transportation in the lung; （7） A muhicenter prospective cohort study provided objective data that depression had causal effect on COPD exacerbation and hospitalization; （ 8 ） Two guidelines for NPPV and mechanical ventilation of AECOPD were initiated by this group. This project has been widely used in clinical practice and promoted the research and treatment of respiratory failure in China.