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題 名 | 急性呼吸窘迫症(ARDS)的實證醫學與治療方針=Evidence Based Medicine and Clinical Guidelines in ARDS Management |
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作 者 | 李琳; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 6:2 民93 |
頁 次 | 頁159-166 |
分類號 | 415.41 |
關鍵詞 | 急性肺傷害; 急性呼吸窘迫症; 實證醫學; 機械換氣; 吐氣末正壓; Acute lung injury; Acute respiratory distress syndrome; Evidence based medicine; Mechanical ventilation; Positive end expiratory pressure; PEEP; |
語 文 | 中文(Chinese) |
中文摘要 | 急性呼吸窘迫症在臨床上主要的特徵包括高度缺氧、兩側X光肺部浸潤、同時沒有淨水壓上升的現象;這種症候群的成因雖然很多,但是急性發炎現象是其共同特點。過去傳統用較大的潮氣容積(10-15ml/kg)在最近幾年的肺部電腦斷層已證實會對ARDS正常部分的肺葉組織造成呼吸器撕裂傷害,因此最近的文獻多主張以較低的潮氣容積(6-8ml/kg)來處理ARDS呼吸器的設定。同時加上較高的吐氣末正壓(15-20 cmH2O)可避免肺泡環塌陷。但也可能同時衍生正常部分肺葉過度充氣,以至於產生血壓下降等問題。 俯伏治療、吸入一氧化氮、體外氧合交換機可應用於較嚴重的ARDS病人以改善其氧合狀況,但這些治療的無法在大規模、前瞻性、隨機取樣對照組的研究中證實改善其預後。水肺治療、外源性介面活性劑的灌入已在動物實驗中証實可減少ARDS的分流,改善氧合狀況。尤其當這些治療合併諸如高PEEP、俯伏治療等一起時更具療效。然而這些方法仍待跨醫學中心一起在人體ARDS實際臨床證實,尤其可考慮在那些氧合狀況很差的ARDS病人身上應用。 高劑量類固醇對ARDS病人的治療已被揚棄。但中劑量類固醇在纖維增生期(7-14天)的ARDS病人可選擇性列入使用。 |
英文摘要 | Acute respiratory distress syndrome (ARDS), characterized clinically by hypoxemia and bilateral pulmonary infiltrates in the absence of elevated hydrostatic pressure, is a disease process associated with many causes, and the common feature to all is inflammation. Elevated airway pressures and the appearance of the lung on CT scan images suggested that the traditional use of a generous tidal volume (10-15 mL/kg) could be injurious to the relatively normal parenchyma in patients with acute lung injury or ARDS. Many investigators recommended using mechanical ventilation with a lower tidal volume (6-8 mL/kg) in patients ALI/ARDS to avoid ventilator-associated lung injury from overdistention. Higher PEEP (15-20 cmH2O) can be used instead to reduce or prevent atelactasis and alveolar flooding but can contribute to overdistention of aerated lung regions and cause circulatory depression. Prone positioning, inhaled NO, ECMO may help to improve oxygenation in severe ARDS but the outcome improvement needs more larger, prospective, randomized, controlled studies to confirm their significance. Partial liquid lung ventilation (PLV)and exogenous surfactant instillation are experimentally efficient to improve animal’s shunt and oxygenation especially while combined with other therapies. Their clinical significance needs further multi-center’s clinical studies especially for those ARDS with refractory oxygenation failure. |
本系統中英文摘要資訊取自各篇刊載內容。