一例急性呼吸窘迫综合征患者的循证非机械通气治疗

Evidence-based non-ventilatory treatments in a case of infection induced acute respiratory distress syndrome

目的为1例肺部感染引起的急性呼吸窘迫综合征患者制定非机械通气治疗方案。方法根据患者临床状况，提出液体管理、药物治疗等临床问题，通过文献检索，根据所获证据给患者制定非机械通气治疗方案。结果现有证据显示：在保证器官灌注的前提下进行限制性液体治疗、早期小剂量应用糖皮质激素、白蛋白联合速尿有助于改善患者预后。NO吸入、β-2肾上腺素受体激动剂、肺表面活性物质、抗真菌药物、粒细胞-巨噬细胞集落刺激因子目前不推荐作为ARDS的常规治疗。结合患者情况，应用证据治疗后，患者最终康复出院。结论以循证医学证据指导临床治疗，能提高ARDS疗效，降低病死率。

Objective To create a nonventilatory treatment plan for one patient with infection induced acute respiratory distress syndrome so as to set an example of evidence-based treatment. Methods With bearing the patient＇ s clinical situations which would have raised concerns in the body fluid and medication applied as well as the retrieved references, MEDLINE with the retrieval words acute lung injury, ALI, acute respiratory distress syndrome, ARDS, fluid management, albumin, diuresis, Methylprednisolone, Corticosteroids, steroid, Ketoconazole, granulocyte macrophage colony stimulating factor, beta-2 adrenergic agonist, inhaled nitric oxide, and urfactant. The strategies were drawn up. Results Based on the evidence that conservative fluid management on the circumstance of ensuring organ perfusion and low-dose steroid in the early stage is helpful, fluid resuscitation combined with vaspactive agents were used before the restricted fluid therapy was given. Albumin and furosemide improved hypoproteinemia. Immediately after ARDS was diagnosed methylprednisolone was added. There was not sufficient evidence supporting the routine use of ketoconazole, granulocyte macrophage colony stimulating factor, beta-2 adrenergic agonist, inhaled nitric oxide, and surfactant. Conclusion Evidence-based therapy of ARDS improves the therapeutic effect and decrease mortality.