糖皮质激素在急性呼吸窘迫综合征中的应用

Corticosteroids treatment in acute respiratory distress syndrome

持久的全身和肺部炎症反应是急性呼吸窘迫综合征（acute respiratory distress syn-drome,ARDS）使用糖皮质激素（简称激素）治疗的基本依据,但目前ARDS患者使用激素的剂量、时间、疗程和效果仍然存在争议.大剂量、短疗程激素疗效欠佳,甚至增加病死率.现阶段认为相对中长疗程（2周～1个月）、小剂量或替代剂量（如甲泼尼龙1 ～2 mg/kg）激素,可降低ARDS病死率,缩短住ICU时间和呼吸机使用时间,并减轻肺纤维化.儿童ARDS的激素治疗仍缺少多中心、随机对照研究.

The presence and persistence of systemic and lung inflammation in children with acute respiratory distress syndrome （ARDS） is the basis for the use of corticosteroids as a therapeutic agent.The trial of ARDS treated with high-dose short-course corticosteroids showed no benefit,even increase motality.At present,the results of randomized controlled trial and meta-analysis suggested that low-dose and replacement-dose methylprednisolone [1-2 mg/（kg＆#183; d）] or equivalent types of corticosteroids may decrease the fatality rate,reduce staying days in ICU and the duration of mechanical ventilation.Use of corticosteroids for ARDS in children is still lack of multicenter randomized controlled trial.