一例術后急性呼吸窘迫綜合征患者的循證藥物治療_《中國循證醫學雜志》

作者：

1. 成都市第二人民醫院老年醫學科（成都 610017）；2. 四川大學華西醫院老年科（成都 610041）；3. 成都市第三人民醫院呼吸科（成都 610031）；4. 成都市第二人民醫院重癥監護室;

關鍵詞：

急性呼吸窘迫綜合征藥物治療循證治療

DOI：

10.7507/1672-2531.20090181

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目的　為1 例手術后發生急性呼吸窘迫綜合征（ARDS）的患者制定藥物治療方案。
方法　根據患者臨床狀況，提出“液體管理、激素使用”等6 個臨床問題，通過OVID 平臺檢索ACP Journal Club（1991 ～ 2009 年）、Cochrane Central Register of Controlled Trials（CENTRAL，2009 年第1 期）、Cochrane Database of Systematic Reviews（CDSR，2009 年第1 期）和MEDLINE（1991 ～ 2009 年）等數據庫，根據所獲證據給患者制定藥物治療方案。
結果　最終納入7 篇系統評價，6 篇隨機對照試驗，證據級別為1 ～ 2 級。現有證據顯示：限制性液體管理策略、糾正低蛋白血癥、速尿和早期小劑量糖皮質激素的使用可提高氧合，改善患者預后；NO 吸入、表面活性物、其他藥物不能降低ARDS 病死率，不推薦作為ARDS 的常規治療。結合患者情況，應用證據治療8 天后，患者轉出重癥監護室，1 月后康復出院。
結論　以循證醫學的方法，采用高質量證據、結合患者情況制定治療方案，能提高ARDS 療效，縮短ICU 住院時間，降低病死率，減少不良反應的發生。

引用本文： 王賓友,董碧蓉,劉雅,何萍,李韞. 一例術后急性呼吸窘迫綜合征患者的循證藥物治療. 中國循證醫學雜志, 2009, 09(9): 1026-1030. doi: 10.7507/1672-2531.20090181 復制

1.	Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl J Med, 2005, 353(16): 1685-1693.
2.	Phua J, Badia JR, Adhikari NK, et al. Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time?: A Systematic Review. Am J Respir Crit Care Med, 2009, 179(3): 220-227.
3.	Lu Y, Song Z, Zhou X, et al. A 12-month clinical survey of incidence and outcome of acute respiratory distress syndrome in Shanghai intensive care units. Intensive Care Med, 2004, 30(12): 2197-2003.
4.	Wiedemann HP, Wheeler AP, Bernard GR, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluidmanagement strategies in acute lung injury. N Engl J Med, 2006, 354(24): 2564-2575.
5.	Mangialardi RJ, Martin GS, Bernard GR, et al. Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis. Ibuprofen in Sepsis Study Group. Crit Care Med, 2000, 28(9): 3137-3145.
6.	Martin GS, Mangialardi RJ, Wheeler AP, et al. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit Care Med, 2002, 30(10): 2175-2182.
7.	Martin GS, Moss M, Wheeler AP, et al. A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med, 2005, 33(8): 1681-1687.
8.	Peter JV, John P, Graham PL, et al. Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis. BMJ, 2008, 336(7651): 1006-1009.
9.	Steinberg KP, Hudson LD, Goodman RB, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med, 2006, 354(16): 1671-1684.
10.	Meduri GU, Marik PE, Chrousos GP, et al. Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature. Intensive Care Med, 2008, 34(1): 61-69.
11.	Bernard GR, Luce JM, Sprung CL, et al. High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med, 1987, 317(25): 1565-1570.
12.	Tang BM, Craig JC, Eslick GD, et al. Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: A systematic review and meta-analysis. Crit Care Med, 2009 Mar 25 [Epub ahead of print] .
13.	Meduri GU, Golden E, Freire AX, et al. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest, 2007, 131(4): 954-963.
14.	Adhikari NK, Burns KE, Friedrich JO, et al. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ, 2007, 334(7597): 779-786.
15.	Davidson WJ, Dorscheid D, Spragg R, et al. Exogenous pulmonary surfactant for the treatment of adult patients with acute respiratory distress syndrome: results of a meta-analysis. Crit Care, 2006, 10(2): R41.
16.	Taut FJ, Rippin G, Schenk P, et al. A Search for subgroups of patients with ARDS who may benefit from surfactant replacement therapy: a pooled analysis of five studies with recombinant surfactant protein-C surfactant (Venticute). Chest, 2008, 134(4): 724-732.
17.	Adhikari NKJ, Burns KEA, Meade MO. Pharmacologic therapies for adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database of Systematic Reviews, 2004, Issue 4.

1. Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl J Med, 2005, 353(16): 1685-1693.
2. Phua J, Badia JR, Adhikari NK, et al. Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time?: A Systematic Review. Am J Respir Crit Care Med, 2009, 179(3): 220-227.
3. Lu Y, Song Z, Zhou X, et al. A 12-month clinical survey of incidence and outcome of acute respiratory distress syndrome in Shanghai intensive care units. Intensive Care Med, 2004, 30(12): 2197-2003.
4. Wiedemann HP, Wheeler AP, Bernard GR, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluidmanagement strategies in acute lung injury. N Engl J Med, 2006, 354(24): 2564-2575.
5. Mangialardi RJ, Martin GS, Bernard GR, et al. Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis. Ibuprofen in Sepsis Study Group. Crit Care Med, 2000, 28(9): 3137-3145.
6. Martin GS, Mangialardi RJ, Wheeler AP, et al. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit Care Med, 2002, 30(10): 2175-2182.
7. Martin GS, Moss M, Wheeler AP, et al. A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med, 2005, 33(8): 1681-1687.
8. Peter JV, John P, Graham PL, et al. Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis. BMJ, 2008, 336(7651): 1006-1009.
9. Steinberg KP, Hudson LD, Goodman RB, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med, 2006, 354(16): 1671-1684.
10. Meduri GU, Marik PE, Chrousos GP, et al. Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature. Intensive Care Med, 2008, 34(1): 61-69.
11. Bernard GR, Luce JM, Sprung CL, et al. High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med, 1987, 317(25): 1565-1570.
12. Tang BM, Craig JC, Eslick GD, et al. Use of corticosteroids in acute lung injury and acute respiratory distress syndrome: A systematic review and meta-analysis. Crit Care Med, 2009 Mar 25 [Epub ahead of print] .
13. Meduri GU, Golden E, Freire AX, et al. Methylprednisolone infusion in early severe ARDS: results of a randomized controlled trial. Chest, 2007, 131(4): 954-963.
14. Adhikari NK, Burns KE, Friedrich JO, et al. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis. BMJ, 2007, 334(7597): 779-786.
15. Davidson WJ, Dorscheid D, Spragg R, et al. Exogenous pulmonary surfactant for the treatment of adult patients with acute respiratory distress syndrome: results of a meta-analysis. Crit Care, 2006, 10(2): R41.
16. Taut FJ, Rippin G, Schenk P, et al. A Search for subgroups of patients with ARDS who may benefit from surfactant replacement therapy: a pooled analysis of five studies with recombinant surfactant protein-C surfactant (Venticute). Chest, 2008, 134(4): 724-732.
17. Adhikari NKJ, Burns KEA, Meade MO. Pharmacologic therapies for adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database of Systematic Reviews, 2004, Issue 4.

《中國循證醫學雜志》

一例術后急性呼吸窘迫綜合征患者的循證藥物治療

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《中國循證醫學雜志》

一例術后急性呼吸窘迫綜合征患者的循證藥物治療

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