急性呼吸窘迫综合征50年:反思与进步

Fifty years of acute respiratory distress syndrome: reflections and progress

急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的发现和提出已经五十余年,其诊断标准、诊疗理念和治疗策略也在不断更新。新型冠状病毒肺炎的全球流行,使得临床医师对于ARDS的发生发展有了新的认识,ARDS的诊断标准需要更新以适应疾病病理生理的发现和诊疗技术的发展;ARDS肺保护通气后,临床医师需要面对患者膈肌功能损伤导致的脱机困难,因此肺保护性通气也在向肺-膈肌保护性通气转变;ARDS的不均一性不仅体现在肺损伤,还体现在对治疗的反应性不同,需要结合ARDS的临床表现区分其亚型,从而更为精准地治疗。因此,ARDS诊断与治疗是在对过去的认知不断反思中前进。

It has been more than 50 years since the recognition of acute respiratory distress syndrome(ARDS),the diagnostic criteria,therapy concept and treatment strategies are constantly being updated. The global epidemic of coronavirus disease 2019 has given a new understanding of the mechanisms and development of ARDS;therefore,ARDS definition needs to be updated to adapt to the understanding of pathophysiology and the development of diagnosis and treatment technology;with the concept of lung protective ventilation of ARDS,clinicians also need to face the difficulty of weaning caused by the iniury of diaphragm function,the lung protective ventilation strategy is changing to the lung-diaphragm protective ventilation strategy;the heterogeneity of ARDS is reflected not only in the lung tissues injury,but also in the different responsiveness to treatment. Through combination with the clinical manifestations of ARDS,the subtypes can be distinguished and the treatment is preciser. Therefore,the diagnosis and therapy of ARDS is based on continuous reflection on the cognition of the past.