前列腺素E1对ARDS肺动脉高压影响的临床观察

目的：观察前列腺素E1（PGE1）对急性呼吸窘迫综合征（ARDS）病人肺循环及预后的影响。方法：15例ARDS病人随机分为PGE1治疗组和对照组,在入重症监护治疗室（ICU）后给予常规治疗和呼吸机治疗,同时置入Swan-Ganz导管,每4小时监测1次MPAP,PCWP,PVR,CO,每日1次在FiO2100%条件下采外周动脉和混合静脉血测定血气,计算Qs/Qt共观察3天。计算入ICU时和住院6天后全部病人APACHEⅢ评分,结果：PGE1（治疗）组MPAP、PVR均较治疗前和对照组明显下降,PCWP,Qs/Qt,CO两相比无统计学意义。APACHEⅢ评分两组无变化结论：PGE110ng/(kg.min)可降低ARDS病人MPAP和PVR,但对预后无明显影响。     

纤维支气管镜对ICU呼吸肌无力患者呼吸机相关肺炎的防治分析

目的评价纤维支气管镜在ICU呼吸肌无力患者呼吸机相关肺炎中的防治效果和临床意义。方法将重症肌无力危象、高位截瘫、急性重症格林巴利综合征、急性脊髓炎等呼吸肌无力患者39例随机分为治疗组和对照组,治疗组20例,采用常规治疗并早期应用纤维支气管镜吸痰、灌洗;对照组19例,采用常规治疗。对两组的呼吸机相关肺炎发生率及血气分析进行观察比较。结果治疗组经纤维支气管镜灌洗后半小时血气分析结果有显著改善,而对照组在治疗后半小时血气分析无明显变化。治疗组呼吸机相关肺炎发生率25%,对照组呼吸机相关肺炎发生率57.9%,对照组呼吸机相关肺炎发生率明显高于治疗组（P〈0.01）。结论纤维支气管镜在防治ICU呼吸肌无力患者呼吸机相关肺炎中可发挥积极、有效、安全的作用,可有效地降低呼吸机相关肺炎的发生率。     

保护性通气联合乌司他丁治疗呼吸窘迫综合症临床观察

目的探讨保护性通气联合乌司他丁治疗急性呼吸窘迫综合征（ARDS）患者的效果。方法将60例ARDS患者随机分为对照组和乌司他丁组,均常规进行肺保护性机械通气（最佳PEEP加潮气量5～8ml／k）。对比两组治疗有效率及治疗前后血气分析变化,并记录住重症监护病房（ICU）时间、住院时间、死亡率等指标以比较其预后。结果保护性通气联合乌司他丁治疗有效率达90％,与对照组60％相比差异有统计学意义（P〈0．01）;乌司他丁组PaO2、氧合指数高于对照组,差异有统计学意义（P〈0．01）,乌司他丁组住ICU时间、住院时间显著短于对照组,死亡率低于对照组。结论保护性通气联合乌司他丁治疗ARDS有助于改善患者的呼吸功能及预后。     

急性呼吸窘迫综合征治疗新进展

急性呼吸窘迫综合征(ARDS)是重症监护病房最常见的致死性并发症,治疗困难.该文综述了近年有关急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的诊断标准、机械通气和药物治疗的新进展.     

糖皮质激素治疗急性呼吸窘迫综合征患者预后的回顾性分析

目的 探讨重症监护病房（ICU）中应用糖皮质激素治疗对急性呼吸窘迫综合征（ARDS）患者预后的影响。方法 回顾性分析医学信息市场重症监护数据库Ⅳ（MIMIC-Ⅳ）中诊断为ARDS患者的临床资料，根据是否使用糖皮质激素将患者分为激素治疗组和常规治疗组，倾向性评分匹配（PSM）平衡2组基线水平，采用Cox比例风险回归模型评价激素治疗与28 d病死率的关系。结果 最终纳入6 118例患者，激素治疗组1 882例，常规治疗组4 236例。用PSM平衡组间基线差异后，激素治疗组较常规治疗组机械通气时间更长、28 d病死率更高（P<0.01）；在住ICU时间、住院时间、住ICU病死率及住院病死率方面，常规治疗组均优于激素组（P<0.05）。Cox比例风险回归分析表明年龄（HR=1.023, P<0.01）、序贯器官衰竭评分（HR=1.113, P<0.01）、首日最差氧合指数（HR=1.001,P<0.01）、白细胞计数（HR=1.004, P<0.01）、冠心病（HR=1.159, P<0.01）、激素应用（HR=1.244,P<0.01）是ARD...     

SARS与ARDS有何差异?

据JAMA最近公布的 2个研究小组报道 ,在危重患者中 ,严重急性呼吸综合征 (SARS)和急性呼吸窘迫综合征 (ARDS)的临床过程有许多共同特征。第一个研究小组对多伦多已住入重症监护病房 (ICU)的 38名危重成年SARS或疑似SARS患者进行回顾性分析。在多伦多医院ICU中SARS和疑似SARS的患者占1 9 % ,与非ICU患者相比 ,ICU患者大多数健康状况差岁数大。在ICU患者中 82 %被确诊为ARDS ,其中有 76 %的患者需要呼吸机 ,37%的患者需要强心剂或作用于血管的药物 ,5 %需要血液透析。 2 8d死亡率占患者34% ,2 8d死亡或呼吸机比率占 5 0 % …     

重症胸外伤治疗中ICU的作用

目的:探讨重症胸外伤救治中重症监护室(intensive care unit ICU)监护及治疗的作用.方法:分析2000-07～2007-08在ICU监护和治疗的96例重症胸外伤临床资料,总结重症胸外伤ICU监护及治疗中的问题.结果:本组治愈率90.06%(87/96),死亡率9.4%(9/96),全组发生应激性溃疡4例(4.2%),急性呼吸窘迫综合征(acute respiratory distress syndrome ARDS)8例(8.3%),多器官功能障碍综合征(multiple organ dysfunction syndrome MODS)9例(9.4%).结论:ICU 内严密的专科治疗和监护处理是治疗重症胸外伤最有效的方法.     

血必净注射液对创伤后急性肺损伤机械通气患者肺保护的临床作用

创伤后急性肺损伤（ALI）是创伤尤其是闭合性胸部创伤后常见的继发性损伤,常发展成为急性呼吸窘迫综合征（ARDS）。并可导致全身炎性反应综合征（SIRS）,多器官功能障碍（MODS）以及多器官功能衰竭（MOF）。目前认为ALI与ARDS是同一病理过程中的两个不同阶段,ARDS是ALI的终末期表现．阻止ALI向ARDS发展是成功防治ARDS的关键。     

呼吸指数对重症创伤患者预后评估的临床研究

目的：研究呼吸指数能否预测重症创伤患者的预后。方法：回顾性分析2010年1～6月收住曲靖市第一人民医院ICU科的重症创伤患者37例,所有患者在入ICU后,立即行血气分析检查得到呼吸指数（RI）,根据预后将患者分为存活组和死亡组,比较两组患者的呼吸指数;以呼吸指数2.5为界限将患者分为低呼吸指数组（RI〈2.5）和高呼吸指数组（RI≥2.5）,比较两组患者的死亡率。结果：患者的年龄、性别差异无统计学意义（P〉0.05）,存活组与死亡组的呼吸指数比较差异有统计学意义（P〈0.05）,低呼吸指数组和高呼吸指数组的死亡率比较差异有统计学意义（P〈0.05）。结论：呼吸指数可以评估重症创伤患者的预后。     

早期气管切开对老年重型颅脑损伤患者呼吸机相关性肺炎的预防作用研究

<正>重型颅脑损伤为重症监护病房(ICU)常见病症,患者多伴有不同程度的昏迷,对于老年患者,由于其身体机能的下降,随着昏迷时间的延长及病情恶化,患者正常的咳嗽、排痰及吞咽功能均可出现障碍,导致呼吸道分泌物不能被及时排出而出现呼吸道堵塞,严重者可引起呼吸抑制,必须接受及时的治疗[1,2]。气管切开机械通气是ICU救治呼吸道阻塞患者的重要方法,也是重症颅脑损伤患者的重要临床救治措施。但其也可诱     

Antipsychotics,Delirium, and Acute Respiratory Distress Syndrome: What Is the Link?

Acute respiratory distress syndrome (ARDS) is an acute inflammatory process that impairs the ability of the lungs to oxygenate and ultimately leads to respiratory failure. Patients who develop ARDS often have prolonged and complicated hospital courses putting them at risk for intensive care unit (ICU) delirium. Patients with ICU delirium often need chemical sedation, mechanical ventilation, prolonged duration of ICU and hospital stays, and they experience long‐term cognitive impairment and increased mortality. In a patient with ARDS, ICU delirium further complicates the hospital course and increases the risk of morbidity and mortality. Antipsychotics are prescribed to decrease the severity and duration of ICU delirium, thus potentially decreasing their risk of morbidity and mortality. However, antipsychotics are associated with many adverse effects including respiratory failure. Given the long‐term sequelae associated with the development of ICU delirium and the risks associated with antipsychotic use, clinicians must weigh the risks and benefits of antipsychotic use. This review investigates the interrelationship between ARDS, delirium, and antipsychotic use. In addition to discussing relevant studies evaluating antipsychotics for the prevention and treatment of delirium, we investigate safety concerns with the use of antipsychotics, especially as they relate to ARDS. Using the data compiled in this review, clinicians can make an informed decision about the use of antipsychotics for the prevention or treatment of delirium, with special consideration for their patients with ARDS. Future studies are needed to critically evaluate antipsychotic timing, dose, and duration for the prevention and treatment of ICU delirium and specifically evaluate the impact in special populations, particularly patients with ARDS.     

Antioxidants in critical care medicine

Critically ill patients in the intensive care unit (ICU) present with a variety of different pathologies, and mortality is high despite extensive multi-organ supportive treatment. Reactive oxygen species (ROS) are believed to play a pivotal role in the pathophysiology of organ dysfunction in the ICU. In particular, the role of ROS as a final common pathway of cell damage has been increasingly emphasised in the adult respiratory distress syndrome (ARDS), in central nervous system traumatic and hypoxic states, and as a cause of ischaemic neurological deficits after subarachnoid haemorrhage. Measurement of total antioxidant status (TAS) has shown improved survival of patients with high TAS and poorer outcomes for those with lower values. Attempts to supplement endogenous antioxidant defences have not demonstrated clear benefits in randomised clinical trials, and the use of free radical scavenging agents have had similar mixed results. Considering the wide variation in the nature and severity of illness in the intensive care population, it is not surprising that clear evidence of the efficacy of antioxidant therapies in improving survival has not been clearly demonstrated. However, single component therapies for complex pathophysiological processes are rarely successful, and the role of antioxidants in the critically ill should be thought of as only part of a rational and logical therapeutic approach.     

无创-有创序贯性机械通气治疗急性呼吸窘迫综合征的疗效

目的 探讨无创-有创序贯性机械通气(MV)治疗急性呼吸窘迫综合征(ARDS)的应用价值.方法 62例需MV的ARDS患者采取随机分为两组,每组31例.A组行气管插管有创MV;B组先给予无创MV,一旦无创通气失败则改气管插管行无创一有创序贯性机械通气.MV前后氧合指数(OI)、呼吸频率(RR)、心率(HR)以及呼吸机相关性肺炎(VAP)发生率、总MV时间、住重症监护病房(ICU)时间、病死率等方面进行比较.结果 与治疗前比较,两组治疗3 h后的OI、RR均有显著改善;B组VAP发生率、总MV时间及住ICU时间显著低于A组(P<0.05).结论 无创一有创序贯性机械通气较有创机械通气能降低VAP发生率、缩短MV时间及住ICU时间.     

Evolution of treatments for patients with acute lung injury

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are acute life-threatening forms of hypoxemic respiratory failure. ALI/ARDS patients require intensive care with prolonged mechanical ventilation. Despite advances in our understanding of the pathophysiology of ALI/ARDS, mortality rates remain > 30% and survivors suffer significant decrements in their quality of life. The evolving understanding of ALI/ARDS and the complex interactions involved in ALI/ARDS open the door for many potential targets for treatment. The condition is characterised by an acute inflammatory state that leads to increased capillary permeability and accumulation of proteinaceous pulmonary oedema. The changes that occur as a result of this inflammation clinically manifest themselves as hypoxemia, infiltrates on chest radiograph and reduced lung compliance. Many years have been dedicated to analysing the complexities involved in ALI/ARDS in order to improve current and future possibilities for treatment, with the aim of improving patient outcomes. Although some therapies have demonstrated benefits of improved oxygenation, such as surfactant and nitric oxide, these benefits have not translated into reductions in the duration of mechanical ventilation or mortality. Inflammatory mediator-targeted therapies were promising early on; however, larger trials have found therapies such as cytokine modulation, platelet-activating factor inhibition and neutrophil elastase inhibitors to be ineffective in the treatment of ALI/ARDS. Preclinical studies with β2-agonists and granulocyte macrophage colony-stimulating factor have shown promise for restoring alveolar capillary barrier integrity or reducing pulmonary oedema, and further studies are being conducted to test for true clinical benefit. Despite previous therapeutic failures, newer surfactant formulations have shown promise, particularly in patients with direct forms of lung injury, and are currently in Phase III trials. Anticoagulant therapy with activated protein C has been shown to improve survival in sepsis, the most common risk factor for the development of ALI/ARDS, and is now being studied in ALI/ARDS. Until new data emerge, the focus must remain on supportive care, including optimised mechanical ventilation, nutritional support, manipulation of fluid balance and prevention of intervening medical complications.     

连续性血液滤过在治疗重症肺炎中的护理研究

目的:观察连续性血液滤过(CVVH) 治疗重症肺炎合并急性呼吸窘迫综合征(ARDS) 患者的临床疗效,评价护理方法的作用.方法:选择重症肺炎合并ARDS患者15例,在常规治疗基础上应用CVVH治疗,实施护理干预如置换液管理、气道管理、生命体征监测、预防感染等护理措施,对患者血液动力学、呼吸功能、血液生化指标的变化进行回...     

Incidence, prevalence and outcome of adult respiratory distress syndrome： A 12-month prospective multicenter survey in Shanghai

A prospective 12-month factors and outcome of acute survey of incidence, risk respiratory distress syndrome(ARDS)was conducted in 15 intensive care units(ICU)in Shanghai during 2001-2002. Of 5320 adult patients admitted to ICUs, there were 108(2％)with ARDS diagnosed according to the 1994 American-Eu-     

Evolution of treatments for patients with acute lung injury

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are acute life-threatening forms of hypoxemic respiratory failure. ALI/ARDS patients require intensive care with prolonged mechanical ventilation. Despite advances in our understanding of the pathophysiology of ALI/ARDS, mortality rates remain > 30% and survivors suffer significant decrements in their quality of life. The evolving understanding of ALI/ARDS and the complex interactions involved in ALI/ARDS open the door for many potential targets for treatment. The condition is characterised by an acute inflammatory state that leads to increased capillary permeability and accumulation of proteinaceous pulmonary oedema. The changes that occur as a result of this inflammation clinically manifest themselves as hypoxemia, infiltrates on chest radiograph and reduced lung compliance. Many years have been dedicated to analysing the complexities involved in ALI/ARDS in order to improve current and future possibilities for treatment, with the aim of improving patient outcomes. Although some therapies have demonstrated benefits of improved oxygenation, such as surfactant and nitric oxide, these benefits have not translated into reductions in the duration of mechanical ventilation or mortality. Inflammatory mediator-targeted therapies were promising early on; however, larger trials have found therapies such as cytokine modulation, platelet-activating factor inhibition and neutrophil elastase inhibitors to be ineffective in the treatment of ALI/ARDS. Preclinical studies with beta2-agonists and granulocyte macrophage colony-stimulating factor have shown promise for restoring alveolar capillary barrier integrity or reducing pulmonary oedema, and further studies are being conducted to test for true clinical benefit. Despite previous therapeutic failures, newer surfactant formulations have shown promise, particularly in patients with direct forms of lung injury, and are currently in Phase III trials. Anticoagulant therapy with activated protein C has been shown to improve survival in sepsis, the most common risk factor for the development of ALI/ARDS, and is now being studied in ALI/ARDS. Until new data emerge, the focus must remain on supportive care, including optimised mechanical ventilation, nutritional support, manipulation of fluid balance and prevention of intervening medical complications.     

Clinical developments for treating ARDS

Acute respiratory distress syndrome (ARDS), is characterised by capillary permeability and pulmonary oedema formation and may complicate a variety of medical and surgical illnesses. As a self-perpetuating state of inflammatory derangement, acute lung injury (ALI)/ARDS is manifest clinically as rapid development of radiographic infiltrates, severe hypoxaemia and reduced lung compliance. Over the years, researchers have made significant progress in elucidating the pathophysiology of this complex syndrome. Therapies targeting specific pathophysiologic steps in the development or persistence of this syndrome are in various stages of laboratory and clinical testing. Results to date have shown nitric oxide (NO) to improve oxygenation in the majority of patients but fail to improve mortality. Surfactant replacement has had limited success in adults, but new formulations and delivery methods may prove beneficial. Several inflammatory mediator-targeted therapies have progressed successfully through early clinical evaluation. Among these, neutrophil elastase inhibitors have shown the most promise and are currently undergoing Phase III trials. Other mediator-targeted therapies, such as prostaglandin E1, IL-10 and platelet activating factor antagonists, have not been found efficacious in large clinical trials of ARDS. However, these therapies, along with coagulation modulators, may have a favourable impact on ARDS by improving outcomes in sepsis, the greatest risk factor for developing this condition. In the interim, supportive care through improvements in mechanical ventilation are beneficial, while specific fluid balance and nutrition strategies may prove advantageous.     

血必净注射液治疗急性呼吸窘迫综合征的疗效观察

目的:探讨血必净注射液治疗急性呼吸窘迫综合征的疗效。方法:选取2010年1月—2011年1月收治的急性呼吸窘迫综合征患者共100例,以随机抽样法分为治疗组和对照组各50例,全部患者均进行常规的治疗,治疗组加用血必净注射液。结果:治疗3 d后,治疗组患者的二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)及血氧饱和度(SaO2)水平均明显高于对照组(P<0.05);治疗1周后,治疗组患者的心率、呼吸频率、C反应蛋白、白细胞计数、IL-1、IL-6及TNF-α水平均明显低于对照组(P<0.05);治疗组患者机械通气时间、平均重症监护(ICU)时间及死亡率均明显低于对照组(P<0.05)。结论:采用血必净注射液治疗急性呼吸窘迫综合征的临床疗效确切,值得在临床上推广应用。