急性呼吸窘迫综合征存活者长期结局研究进展

The progress of long-term outcomes in survivors of acute respiratory distress syndrome

随着重症医学的发展和急性呼吸窘迫综合征(ARDS)呼吸支持手段的进步,ARDS短期病死率大大下降,存活者越来越多,存活者的长期结局越来越受到关注。ARDS存活者肺功能恢复比较完全,但可遗留多种后遗症,包括生理功能(肌无力、活动能力受限)、认知功能和精神心理(焦虑、抑郁、创伤后应激障碍)障碍,被称为重症监护后综合征,可持续到ARDS后5年,导致生命质量下降,增加了家庭负担和医疗资源消耗。ARDS患者患病前的健康情况(如并存病、肥胖、自理能力、精神状况)、生活方式(如吸烟)以及重症监护病房(ICU)期间相关变量(如谵妄、皮质激素、阿片类药物、获得性肌无力、低氧血症)对存活者的长期结局有重要影响。发现ARDS长期结局不良的高危患者及可改变的危险因素,并及时采取干预措施,对减少ARDS后的功能障碍有重要意义。ICU内及ICU后干预措施是否可有效改善ARDS存活者的长期结局,还需要进一步研究和验证。

Along with the development of critical care medicine and the advances in respiratory support, the short-term mortality of acute respiratory distress syndrome （ARDS） has significantly decreased, and many patients have survived. Then the long-term outcomes of survivors of ARDS is getting more and more attention. ARDS survivors can have complete recove^7 of puhnonary function, but they might continue to present sequelae including physical impaimaent （muscle weakness and limited activities）, cognitive impaimaent and psychologic problem （anxiety, depression, post-traumatic stress disorder） over five years, called as post intensive care syndrome, resulting in a decline in quality of life and increasing the burden of family and medical resource consumption. For ARDS patients, some factors have a significant impact on the long- term outcomes of survivors, including pre-ARDS health status （such as comorbidity, obesity, functional independence, mental health status）, lifestyle （such as smoking） and the relevant variables during their stay in ICU （such as delirium, corticosteroids, opioids, acquired muscle weakness, hypoxemia）. Identifying the modifiable risk factors for long-term outcomes of ARDS patients, and taking timely intervention measures have important significance for decline of post-ARDS dysfunction. It is unclear whether interventions in ICU or post-ICU can effectively improve long-tema outcomes in ARDS survivors, and further investigation and validation are required.