肺炎诱发急性呼吸窘迫综合征诊治策略的思考

Pneumonia induced acute respiratory distress syndrome：consideration of strategy in diagnosis and ther-apy

肺炎诱导的急性呼吸窘迫综合征（ acute respiratory distress syndrome,ARDS）较肺外因素导致的ARDS在病理、临床表现、影像学改变及肺力学等方面更为复杂,有更为显著的异质性,不仅有肺泡的弥漫性损伤,还有气道的严重损害,常有肺气漏、肺出血、肺水肿同时存在；不仅有肺顺应性下降,还可有气道阻力增加。机械通气策略遵循肺保护通气策略,但应个体化；临床诊断ARDS并不一定是病理学意义的ARDS,很多病例仅仅是肺炎的改变,因此ARDS的治疗策略并非都适合所有临床诊断肺炎合并ARDS的患者,反之一些循证医学认为证据不充分的手段也并非无效；肺炎诱发ARDS需要综合性治疗措施,包括抗感染、脏器支持、营养免疫支持等,呼吸支持仅是其中的主要手段之一。

The pathology, clinical manifestation, radiologic changes and pulmonary mechanics are more complicated in pneumonia induced ARDS than in other extrapulmonary origins. Heterogeneity is obvi-ous with increased respiratory tract resistance and decline of lung compliance. The injury of both tract and alveoli is more severe including airleak,pulmonary hemorrhage,pulmonary edema etc. Lung protective strate-gy should be followed in ventilatory support,but in some cases this will not work,thus individual treatment should be performed accordingly. In addition,clinical diagnosis of ARDS according to Berlin definition is not real ARDS pathologically, some cases are simply pneumonia, therefore treatment for ARDS is not always working. Integrity treatment is needed in pneumonia induced ARDS including antibiotics and other organ sup-port.