儿童急性呼吸窘迫综合征液体管理策略的研究进展

Advances in the fluid management strategies of pediatric acute respiratory distress syndrome

儿童急性呼吸窘迫综合征(pediatric acute respiratory distress syndrome,PARDS)是由多种病因引起的多种促炎因子介导的肺部炎症反应综合征,以非心源性肺水肿为主要特征;其病理生理学特征是肺泡-毛细血管膜的完整性被破坏和屏障功能障碍。PARDS在临床上以支持治疗为主。液体管理策略是非通气治疗措施中的重要组成部分,但目前液体管理仍缺乏明确的定义与广泛接受的共识。合适的液体管理策略有助于改善肺水肿,维持正常循环灌注,防止重要脏器发生功能衰竭,并改善患儿预后。临床上应正确评估PARDS患儿的容量状态,实施目标导向性、阶段性差异化液体管理策略,但根据PARDS表型进行液体管理的临床效果仍有待评估。

Pediatric acute respiratory distress syndrome(PARDS)is a pulmonary inflammation syndrome caused by a variety of proinflammatory factors induced by many causes,which is mainly characterized by noncardiogenic pulmonary edema.The main pathophysiological feature is the destruction of the integrity of the alveolar capillary membrane,and the loss of the alveolar epithelial-endothelial barrier function.In the PARDS′s clinical practice,the mainstay of the treatment is supportive.Although there is still no clear definition and general consensus or guidelines,appropriate liquid therapy is an important part of non-ventilatory treatment measures.Proper fluid management strategy is helpful to improve pulmonary edema,maintain normal circulatory perfusion,prevent functional failure of important organs and improve the prognosis of patients.According to volume status,implementing the goal-oriented and phased differentiated fluid management strategy is significant for the therapy of PARDS patients.However,the effects of fluid strategy management according to PARDS phenotypes remain to be evaluated.