ALI/ARDS患者糖皮质激素的治疗效果和时机

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是临床各科经常遇到的急症,其发病机制主要是中性粒细胞向炎症部位的移动,释放出大量的炎性介质和细胞因子,引起肺泡毛细血管膜通透性增高,弥漫性肺损伤和蛋白性肺泡水肿液聚集等病理生理改变。临床表现为呼吸困难、呼吸窘迫、顽固的低氧血症,虽然使用机械通气和呼气末正压通气(PEEP)后,其病死率有所下降,但仍然维持在50%左右。就糖皮质激素的作用机制,对不同原因引起的ALI/ARDS治疗效果,使用时机作一综述,期望对ALI/ARDS治疗过程中糖皮质激素的使用予以规范。

Treatment Efficary and Apply Juncture of Glucocorticoid of Acute Lung Injury and Acute Respiratory Distress Syndrome

Acute lung injury and acute respiratory distress syndrome(ALI/ARDS) is a popular emergency of all clinician.the pathogenesis of ALI/ARDS is migration of neutrophil to inflammation site.which release massive inflammatory mediator and cytokines. It can increase alveolar-capillary membrane permeability, diffuse alveolar damage, alveolar pulmonary edema. Clinical manifestation is dyspnea, distress, intractable hypoxemia. The mortality sustains about 50%, although we use the mechanical ventilation and post end-expiratory pressure(PEEP), the mortality is decrease in some degree.To overview the mechanism of glucocorticoid, effect of ALI/ARDS of defferent causes,and apply juncture. We hope it may specifit treatment of glucocorticoid to ALI/ARDS.