急性呼吸窘迫综合征的诊治进展

Progress in the diagnosis and treatment of acute respiratory distress syndrome

急性呼吸窘迫综合征(ARDS)是ICU常见的综合征之一,尽管有大量基础和临床研究,目前仍无有效的治疗药物,治疗主要是支持性的。了解ARDS的诊治进展对于降低患病率和病死率至关重要。目前ARDS的诊断标准仍采用2012年的柏林标准,发病机制核心是炎症反应失调、内皮和上皮细胞通透性增加。通气策略中,强调驱动压和机械能的重要性,中重度ARDS推荐俯卧位治疗,重度ARDS推荐体外膜肺氧合(ECMO)治疗,丰富的表型异质性是ARDS患者缺乏有效治疗的原因。笔者就ARDS的诊断、发病机制、通气策略、通气辅助、药物、表型异质性等方面进行综述。

Acute respiratory distress syndrome(ARDS)is the one of common syndromes in ICU,despite numerous basic and clinical studies,there are still no effective therapeutic agents for ARDS,and treatment is primarily supportive.Understanding the advances in the diagnosis and treatment of ARDS is essential to reduce the prevalence and mortality rates.Currently,the diagnostic criteria for ARDS still use the Berlin criteria from 2012,and the pathogenesis centers is the dysregulated inflammatory response and the increase of endothelial and epithelial cell permeability.The importance of driving pressure and mechanical energy is emphasized in ventilation strategies,with prone position therapy recommended for moderate to severe ARDS and extracorporeal membrane pulmonary oxygenation(ECMO)therapy for severe ARDS,the rich phenotypic heterogeneity is responsible for ARDS patients lacking of effective treatment.The author reviews the diagnosis,pathogenesis,ventilation strategies,ventilation assistance,drugs,and phenotypic heterogeneity of ARDS.