Acute respiratory distress syndrome
Acute respiratory distress syndrome
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DOI：
10.1038/s41572-019-0069-0
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发表时间：
2019-03-14
影响因子：
81.5
通讯作者：
Calfee, Carolyn S.
中科院分区：
文献类型：
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作者：
Matthay, Michael A.;Zemans, Rachel L.;Calfee, Carolyn S.
急性呼吸窘迫综合征（ARDS）是重症患者呼吸衰竭的常见原因，其定义为非心源性肺水肿急性发作、低氧血症以及需要机械通气。ARDS最常发生于肺炎、败血症、胃内容物误吸或严重创伤的情况下，在全球重症监护病房的所有患者中约占10%。尽管有所改善，但大多数研究中的死亡率仍高达30% - 40%。ARDS患者的病理标本经常显示弥漫性肺泡损伤，实验室研究表明肺泡上皮和肺内皮均受损，导致富含蛋白质的炎性水肿液在肺泡间隙积聚。诊断基于共识的综合征标准，并针对资源不足的环境和儿科患者进行了修改。治疗侧重于肺保护性通气；尚未确定特定的药物疗法。ARDS患者的长期预后越来越被视为重要的研究目标，因为许多ARDS患者虽然存活下来，但却有持续的功能和/或心理后遗症。未来的方向包括努力促进更早地识别ARDS，确定有反应的患者亚群，以及不断努力了解肺损伤的基本机制以设计特定的治疗方法。
The acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in critically ill patients and is defined by the acute onset of noncardiogenic pulmonary oedema, hypoxaemia and the need for mechanical ventilation. ARDS occurs most often in the setting of pneumonia, sepsis, aspiration of gastric contents or severe trauma and is present in similar to 10% of all patients in intensive care units worldwide. Despite some improvements, mortality remains high at 30-40% in most studies. Pathological specimens from patients with ARDS frequently reveal diffuse alveolar damage, and laboratory studies have demonstrated both alveolar epithelial and lung endothelial injury, resulting in accumulation of protein-rich inflammatory oedematous fluid in the alveolar space. Diagnosis is based on consensus syndromic criteria, with modifications for under-resourced settings and in paediatric patients. Treatment focuses on lung-protective ventilation; no specific pharmacotherapies have been identified. Long-term outcomes of patients with ARDS are increasingly recognized as important research targets, as many patients survive ARDS only to have ongoing functional and/or psychological sequelae. Future directions include efforts to facilitate earlier recognition of ARDS, identifying responsive subsets of patients and ongoing efforts to understand fundamental mechanisms of lung injury to design specific treatments.