急性呼吸窘迫综合征治疗进展-急诊医学专业论文.docxVIP

PAGE PAGE 2 急性呼吸窘迫综合征治疗进展 中文摘要 急性呼吸窘迫综合征作为多器官功能衰竭在肺部的表现，一直是重症监护病 房的常见病和多发病，病死率较高，目前尚没有特效治疗手段，主要的治疗措施 是控制原发病和支持治疗。有创机械通气是呼吸支持治疗的主要方法，相关通气 策略如肺保护通气，肺复张和复张后高呼气末正压维持已经应用于临床治疗，得 到广泛认可并可确切降低死亡率。一些新的通气模式如高频振荡通气和神经辅助 通气虽可改善患者氧合或人机协调，但不能降低患者的死亡率。俯卧位通气和液 体通气可作为补充。调控机体失控的炎症反应，作为急性呼吸窘迫综合征的病因 治疗，是改善患者预后的必经之路，在动物实验中相关治疗虽可减轻肺损伤、降 低死亡率，但未取得满意的临床效果，有待进一步研究。药物治疗能够改善患者 症状，为其他治疗赢得时间，但不能降低患者的死亡率。近期应用神经肌肉阻滞 药治疗急性呼吸窘迫综合征有效的实验，其阳性研究结果有待更多的随机对照实 验研究重复。重症急性呼吸窘迫综合征患者可应用体外生命支持，等待肺功能恢 复，为患者其他治疗提供条件和生命支持。随着分子生物学的飞速发展,免疫、基 因以及细胞治疗将给急性呼吸窘迫综合征的治疗带来新的希望。 [关键词] 急性呼吸窘迫综合征；治疗；机械通气；体外膜氧合 Recent advances in the treatment of acute respiratory distress syndrome Abstract Acute respiratory distress syndrome as Multiple organ dysfunction syndrome in the lung performance, has always been the common disease and frequently-occurring disease in the intensive care unit. There is a higher mortality and no special treatment for acute respiratory distress syndrome .The main treatment measures is to control the original disease and support treatment. The mechanical ventilation is the main method of respiratory support. Related ventilatory strategy such as lung ventilation protection, open the lung and keep the lung open has been applied to clinical treatment, widely recognized and exact reduce the mortality. Some new ventilation modes such as high-frequency oscillatory ventilation and neurally adjusted ventilatory assist although can improve the patient with oxygen or the man-machine coordinated, but cant reduce the mortality. Prone position ventilation and liquid ventilation can be used as added. Control Over-exuberant inflammation ,as the etiological treatment of acute respiratory distress syndrome,is crucial to improve the prognosis of patients. In animal experiments related treatments can reduce the lung injury and the mortality, but did not obtain satisfactory clinical effect. It needs more further research. Pharmacotherapy can improve patients symptoms and gain time for any other treatment , but cant lower a