ARE CORTICOSTEROIDS SALVAGE THERAPY FOR REFRACTORY ACUTE RESPIRATORY-DISTRESS SYNDROME
ARE CORTICOSTEROIDS SALVAGE THERAPY FOR REFRACTORY ACUTE RESPIRATORY-DISTRESS SYNDROME
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DOI：
10.1016/s0002-9610(99)80022-1
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发表时间：
1995-12-01
影响因子：
3
通讯作者：
BURCH, JM
中科院分区：
文献类型：
--
作者：
BIFFL, WL;MOORE, FA;BURCH, JM
背景：以进行性肺间质纤维增生为特征的晚期急性呼吸窘迫综合征（ARDS）与死亡率（约80%）相关。尽管先前的大型前瞻性试验未能显示类固醇对早期ARDS的益处，但最近的小型报告描述了晚期ARDS患者生存率的提高。认识到早期和晚期ARDS的病理差异，我们对难治性晚期ARDS患者采用类固醇治疗。患者和方法：在5年的时间里，我们用琥珀酸甲基强的松龙钠（每6小时1至2 mg/kg）治疗了6例死于孤立性难治性ARDS的患者。连续记录通气参数和肺损伤评分，并根据临床反应停用类固醇。结果：经过16天的高级机械通气支持后，使用类固醇。到类固醇治疗的第7天，PaO2/FiO(2)比值（84至172）和肺损伤评分（3.6至2.9）有临床显著改善；5例（83%）存活。结论：类固醇治疗对难治性晚期ARDS患者有效。需要前瞻性试验来确定适应症、干预时间、剂量和持续时间以及类固醇治疗的注意事项。
BACKGROUND: Late acute respiratory distress syndrome (ARDS), characterized by progressive pulmonary interstitial fibroproliferation, is associated with mortality >80%. Although previous large prospective trials failed to show a benefit of steroids in early ARDS, recent small reports describe improved survival in patients with late ARDS. Recognizing the pathogenetic differences between early and late ARDS, we employed steroid therapy in patients with refractory late ARDS.PATIENTS AND METHODS: Over a 5-year period, we treated 6 patients who were dying of isolated refractory ARDS with methylprednisolone sodium succinate (1 to 2 mg/kg every 6 hours). Ventilatory parameters and lung injury scores were serially recorded, and steroids were weaned based on clinical response.RESULTS: Steroids were instituted after 16 days of advanced mechanical ventilatory support. By day 7 of steroid therapy, there was clinically significant improvement in PaO2/FiO(2) ratios (84 to 172) and lung injury scores (3.6 to 2.9); 5 patients (83%) survived.CONCLUSIONS: Steroid therapy appears to be effective in patients with refractory late ARDS. Prospective trials are needed to define the indications, timing of intervention, dose and duration, and precautions of steroid therapy.