呼吸窘迫综合征,成人型

摘要： Objective To investigate the ideal persistence time of prone position ventilation in patients with severe acute respiratory distress syndrome (ARDS).Methods Collect 78 cases of severe ARDS admitted to the ICU unit of Sichuan Provincial People's Hospital from October 2012 to June 2014,all the ARDS patients needed to receive 8 h/day prone position continuous 5 day.For each of the prone position ventilation,ultrasound patterns were recorded and the aeration scores were calculated at the beginning of the prone position(T0)and 2 h(T1),4 h(T2),6 h(T3),8 h(T4) later.The correlation of the aeration score variation (ASV) and the arterial blood gas indexes (pH,PaO2,PaCO2,PaO2/FiO2) were recorded also.The adverse reactions,ventilator situation and oxygen fraction after 7 days,28-day mortality were monitored.Results The aeration score of the lung at T1,T2,T3,T4 was significantly reduced than T0 all,the ventilation situation of mainly areas was improved after 2 h PPV (P ＜ 0.05),4 h later it was not distinguished(P ＞ 0.05);the value of PaO2,PaO2/FiO2 was greater at T1,T2,T3,T4 than T0 (P ＜ 0.05),the value of the oxygen fraction was significant increased at T2 than T1 (t =2.840,P ＜ 0.05);the number of patients with oxygen fractions ＞300 mmHg after 5 days PPV was 65(83.3％);there were 30(38.5％) patients free of mechanical ventilation after 7 days;the 28-day mortality was 7 (8.97％).Conclusion In patients with severe ARDS,applicating 2-4 hours validity of prone position ventilation significantly improves the pulmonary ventilation,more than 4 h PPV do not better for patients probably.%目的 用肺部超声评估重度急性呼吸窘迫综合征(ARDS)患者俯卧位通气不同时间点肺通气状况的改变,以确定俯卧位通气的最佳维持时间.方法 收集2012年10月至2014年6月四川省人民医院重症医学科(ICU)收治的78例重度ARDS患者为研究对象,连续行俯卧位通气5d,每天8h.记录每次俯卧位即刻(T0)、2 h(T1)、4 h(T2)、6 h(T3)、8 h(T4)的肺通气评分和动脉血气分析[包括酸碱度(pH)值、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)及氧合指数(PaO2/FiO2)],观察患者俯卧位通气时不良反应、7d后的机械通气状态、氧合指数及28 d存活率.结果 与T0比较,俯卧位T1、T2、T3、T4点肺重力依赖区的肺通气评分均呈下降趋势,大部分区域俯卧位2h后的肺通气评分即有明显改善(P＜0.05),4h后肺通气评分继续改善不明显(P＞0.05);T1、T2、T3、T4的PaO2、PaO2/FiO2均高于T0(P＜0.05),T2的PaO2/FiO2高于T1(t=2.840,P＜0.05),其余相邻两点的PaO2、PaO2/FiO2相比,差异无统计学意义(P＞0.05);俯卧位5d后65例(83.3％)患者氧合指数＞ 300 mmHg;7d后30例(38.5％)患者可以脱机;28 d死亡率为7例(8.97％).结论 俯卧位通气2～4h可显著改善重度ARDS患者肺重力依赖区的通气状况,超过4h的俯卧位通气可能并不能带来更多的益处.

摘要： 目的 探讨急性呼吸窘迫综合征(ARDS)患者血管外肺水指数(EVLWI)和肺血管通透性指数(PVPI)的动态变化对其预后的影响.方法 选择2012年7月至2014年7月宁夏医科大学总医院重症医学科(ICU)符合ARDS柏林定义患者70例,根据28 d生存情况分为存活组和病死组.脉搏指示剂持续心排出量监测技术(PiCCO)两组患者入院1～4 d EVLWI(EVLWI1 ～ EVLWI4)和PVPI(PVPI1 ～ PVPI4),以及其差值△EVLWI(EVLWI1～ EVLWI4)和△PVPI(PVPI1～PVPI4).比较两组急性生理与慢性健康状况评分(APACHEⅡ),序贯器官衰竭评分(SOFA)、EVLWI和PVPI及其变化、△EVLWI、△PVPI、氧合指数(OI)、中心静脉压(CVP)及器官功能障碍数目等参数.对影响预后的因素进行单因素和logistic回归分析,并绘制受试者工作特征曲线(ROC).结果 存活组和病死组不同时相点EVLWI和PVPI组间比较,入院1～2 d EVLWI和PVPI两组间差异无统计学意义,而3～4d病死组均高于存活组(均P＜0.01).存活组和病死组EVLWI和PVPI动态变化趋势比较,存活组1 ～4 d EVLWI和PVPI随治疗逐渐下降(均P＜0.05),而病死组1～4d变化趋势差异无统计学意义.△EVLWI和△PVPI存活组明显高于病死组,为28 d预后的独立危险因素(均P＜0.05).ROC曲线和28 d生存曲线显示,△PVPI预测ARDS预后的ROC曲线下面积(AUC)为0.812,最佳截断值为1.2,且△PVPI＞ 1.2中位生存期明显长于△PVPI≤1.2.结论 ARDS患者持续动态监测EVLWI和PVPI对预后的预测价值优于单次数值,且△EVLWI和△PVPI为ARDS预后的独立危险因素,可作为ARDS患者预后评估的辅助指标之一.%Objective To investigate the dynamic changes of extra vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) on the prognosis of acute respiratory distress syndrome (ARDS), and predict the risk factors affecting prognosis of ARDS.Methods 70 patients meeting ARDS Berlin definition, who were admitted to the ICU from July 2012 to July 2014, were analyzed with a prospective method.The patients were divided into a survival group and a death group according to their survival situation in 28 days.EVLWI (EVLWI1-EVLWI4), PVPI (PVPI1-PVPI4), △EVLWI (subtracting EVLWI day4 from day1), and △PVPI (subtracting PVPI day4 from day1) of the two groups of patients from the 1st day to the 4th day were monitored by the pulse indicator continuous cardiac output (PiCCO).Parameters including the acute physiology and chronic health evaluation (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, EVLWI, PVPI, △EVLWI, △PVPI, oxygenation index(OI),CVP, the number of organ dysfunction were compared between the two groups.Univariate analysis and multivariate logistic regression were used to analyze the independent risk factors associated with prognosis.Receiver operating characteristic curve (ROC curve) was drawn to evaluate the prediction performance of those risk factors in the prognosis of ARDS.Results Comparison of EVLWI and PVPI between the survival group and the death group of ARDS patients at different time points:EVLWI and PVPI showed no statistical difference from the 1 st day to the 2th day after admission, but those two parameters in the death group were higher than those in the survival group from the 3rd day to the 4th day after admission (P ＜0.01).The comparison of the dynamic changes of EVLWI and PVPI within the two groups:the EVLWI and PVPI in the survival group declined gradually from 1st day to 4th day after treatment, but that changing trend in the death group showed no statistical difference.△EVLWI and △PVPI changes in the survival group were higher than in the death group (P ＜ 0.01).They were independent risk factors of patients 28-day prognosis (P ＜ 0.05).ROC curve and 28-day survival curve showed that the area under ROC curve of △PVPI predicting prognosis of patients with ARDS was 0.812, when the optimal cut off value was 1.2, and the median survival period in △PVPI ＞1.2 group was longer than that in the △PVPI ≤ 1.2 group.Conclusions The continuous dynamic observation of EVLWI and PVPI changes is better than that of a single detection.△EVLWI and △PVPI are independent risk factors and can be used as an auxiliary indicator for the prognosis of patients with ARDS.

摘要： Objective To evaluate the effects of high-frequency oscillatory ventilation (HFOV) on mortality in patients with acute respiratory distress syndrome (ARDS).Methods Randomized controlled trials (RCTs) of HFOV as compared with conventional mechanical ventilation (CMV) in adult patients with ARDS from January 1970 to May 2013 were recruited.The data were analyzed with the methods recommended by the Cochrane Collaboration's software RevMan 5.0.Results Six RCTs using HFOV in adult patients with ARDS were collected for analysis.Among 1 634 eligible ARDS patients,827 of them were enrolled into HFOV group and the reminder into CMV group.Meta-analysis revealed HFOV did not significantly decrease the hospitalization or 30-day mortality of adult ARDS patients (OR =0.95,95％ CI 0.62-1.46,P =0.83).Conclusion Compared with CMV,HFOV dose not improve prognosis in adult patients with ARDS.Thus more high-quality RCTs with larger samples are warranted.%目的 评估高频振荡通气(HFOV)对急性呼吸窘迫综合征(ARDS)患者预后的影响.方法 联机检索MEDLINE、Embase、Web of Science和CNKI等中英文数据库,收集1970年1月至2013年5月HFOV治疗成人ARDS的英文和中文临床随机对照研究(RCT)文献,按纳入与排除标准选择文献,采用RevMan 5.0软件对数据进行荟萃分析.结果 共纳入6篇RCT文献,入选1 634例ARDS患者,HFOV治疗组827例,常规机械通气治疗(CMV)对照组807例.将HFOV对成人ARDS患者住院或30 d病死率进行荟萃分析:与CMV相比,HFOV不能降低成人ARDS患者住院或30 d病死率,OR值=0.95 [95％可信区间(CI)0.62～1.46,P=0.83].结论 与CMV相比,HFOV不能改善成人ARDS患者的预后.

摘要： 目的 探讨脐带间充质干细胞(umbilical cord mesenchymal stem cells,UMSC)治疗急性百草枯中毒致肺损伤的临床疗效和安全性.方法 将2008年12月至2011年12月广州市第12人民医院收治的13例急性百草枯中毒致肺损伤患者分为观察组(5例)及对照组(8例).所有患者均予常规治疗,观察组加用UMSC治疗.应用欧洲重症医学监护医学协会(ESICM)感染相关问题工作组制定的SOFA评分体系,结合我国急性生理学和长期健康评价Ⅱ(acute physiology and chronic health evaluation,APACHEⅡ)对患者进行病情序贯器官衰竭综合评分[SOFA(a)]；同时行肺损伤评分(LIS)评价损伤程度.比较两组患者中毒后第1、3、5、7、14及15天后最大SOFA(a)的差异.结果 观察组患者中毒后第15天最大的SOFA(a)评分为(1.80±2.05),明显低于对照组(13.50±7.59),差异有统计学意义(P＜0.05)；观察组治疗后LIS(0.45±0.27)比治疗前(1.15±0.34)明显下降,也明显低于对照组治疗后(2.94±1.20),差异均有统计学意义(P＜0.01).观察组5例患者均存活,复查无诉不适,肝、肾、肺等功能复查正常.肺部CT复查1例患者左下肺后段原病灶部分未完全吸收,其他患者均未见异常.对照组8例患者有1例存活,其余7例均死亡.观察组患者在接受UMSC治疗期间无出现寒战、发热等不良反应.结论 UMSC治疗急性百草枯中毒致肺损伤可能有一定临床应用价值.%Objective To evaluate the clinical effect and safety of human umbilical cord mesenchymal stem cells (HUCMSCs) in the treatment of lung injury caused by acute paraquat poisoning.Methods Thirteen patients with lung injury caused by acute paraquat poisoning,who were admitted to Guangzhou No.12 People's Hospital from December 2008 to December 2012,were divided into HUCMSC group (n=5) and control group (n=8).All patients received conventional treatment,while the HUCMSC group was treated with HUCMSCs as an addition.Sequential Organ Failure Assessment (SOFA) system,which was created by the Infection Section of European Society of Intensive Care Medicine,and Acute Physiology and Chronic Health Evaluation Ⅱ were used to acquire the SOFA scores of patients.The lung injury was evaluated with lung injury score (LIS).The two groups were compared with respect to maximum SOFA scores at 1,3,5,7,14,and 15 days after paraquat poisoning.Results The HUCMSC group showed significantly lower maximum SOFA scores than the control group at 15 d after poisoning (1.80±2.05 vs 13.50±7.59,P＜0.05) The LISs of the HUCMSC group after treatment (0.45±0.27) were significantly lower than those of the HUCMSC group before treatment (1.15±0.34)and those of the control group after treatment (2.94±1.20) (P＜0.01).In the HUCMSC group,all patients survived,and they complained no discomfort and showed normal liver,kidney,and lung functions in reexamination; one patient showed incompletely absorbed shadow in the posterior segment of the left lower lobe of the lung during lung CT scan,and no abnormal findings were seen in other patients.In the control group,one patient survived,and others died.No adverse reactions,such as chill and fever,were presented in the HUCMSC group.Conclusion HUCMSCs show promise for clinical application in the treatment of lung injury caused by acute paraquat poisoning.

摘要： 目的 明确常规树突状细胞(cDCs)靶向性的FMS样酪氨酸激酶3(FLT3)信号通路对急性肺损伤(ALI)早期炎症反应及肺损伤的调控效应及可能机制.方法 C57BL/6小鼠随机分为正常对照组、ALI组、FLT3-配体(ligand)( FLT3L)预处理组、来他替尼预处理组和二甲基亚砜(DMSO)对照组,分别给予FLT3L、来他替尼预处理5d后复制ALI模型,24 h后处死小鼠留取肺组织,采用流式细胞术检测评价肺cDCs的数量和成熟程度;比色法检测髓过氧化物酶(MPO)活性反映中性粒细胞浸润;多聚酶链反应(PCR)检测转录因子T-bet/GATA-3 mRNA比值反映Th1/Th2免疫反应平衡;计算肺湿重/体重比评价肺水肿程度;肺组织HE染色行组织病理学检查和肺损伤评分反映肺损伤程度.结果 与正常对照组相比,ALI组小鼠肺cDCs的数量[(1.71％±0.35％)比(0.68％±0.15％)]及其MHC Ⅱ表达[(21.5％±4.5％)比(6.7％±2.8％)]和CD80表达[(31.2％±5.3％)比(7.3％±1.7％)]均显著增高(均P＜0.05).与ALI组相比,FLT3L预处理进一步增加肺cDCs的数量[(2.81％±0.42％)比(1.71％±0.35％),P ＜0.05]及其MHC Ⅱ表达[(40.8％±6.7％)比(21.5％±4.5％),P＜0.05]和CD80表达[(59.9％±8.1％)比(31.2％±5.3％),P＜0.05],并上调肺组织MPO活性[(7.2±0.4) U/g比(5.3±0.6)U/g]及T-bet/GATA-3 mRNA比值(％)[(600±222)比(220±48)],加重肺水肿和肺损伤.与DMSO对照组相比,来他替尼预处理显著减少肺cDCs的数量[(0.90％±0.28％)比(1.65％±0.44％),P＜0.05]及其MHC Ⅱ表达[(23.1％±3.1％)比(35.6％±6.2％),P ＜0.05]和CD80表达[(22.9％±5.4％)比(43.3％±7.8％),P＜0.05],并下调肺组织MPO活性[(4.3±0.3) U/g比(6.5±0.5)U/g]及T-bet/GATA-3 mRNA比值[(190％±33％)比(400％±72％)],减轻肺水肿和肺损伤.结论 FLT3信号通路能有效调控肺cDCs的数量和成熟程度,通过拮抗FLT3信号通路可显著抑制ALI早期肺cDCs的聚集和分化成熟,进而减轻肺部炎症反应和肺损伤.%Objective To explore the effects of FLT3 signaling on the accumulation and maturation of pulmonary conventional dendritic cells (cDCs) and determine whether or not the inhibition of FLT3 signaling may attenuate acute lung inflammation/injury (ALI).Methods C57BL/6 mice were pretreated separately with FLT3-ligand (FLT3L) and lestaurtinib for 5 days.Murine model of ALI was subsequently induced by an intra-tracheal instillation of lipopolysaccharide (LPS) and lung specimens were harvested 24 hours later.The accumulation and maturation status of pulmonary cDCs were assessed by flow cytometry.Lung myeloperoxidase (MPO) activity was measured to evaluate the infiltration of neutrophils.The ratio between transcription factors T-bet and GATA-3 mRNA was determined to estimate the balance of Th1/Th2 response.Lung injury was estimated by lung wet weight/body weight ratio (LWW/BW) and histopathological assessment.Results LPS challenge resulted in rapid accumulation and maturation of pulmonary cDCs.FLT3L pretreatment further stimulated the accumulation and maturation of pulmonary cDCs,leading to a marked deterioration of LWW/BW and lung histopathological changes.Meanwhile,the lung MPO activity and T-bet/GATA-3 mRNA ratio were boosted by the administration of FLT3L.In contrast,the lestaurtinib pretreatment inhibited the accumulation and maturation of pulmonary cDCs,leading to a significant improvement of LWW/BW and lung histopathological changes.The administration of lestaurtinib also suppressed the lung MPO activity and T-bet/GATA-3 mRNA ratio in the lung.Conclusions FLT3 signaling attenuates ALI by regulating the accumulation and maturation of pulmonary cDCs,indicating a potential pharmacotherapy for ALI.

摘要： 目的 探讨己酮可可碱联合机械通气治疗急性呼吸窘迫综合征(ARDS)的临床疗效.方法 将64例ARDS患者随机分为对照组和己酮可可碱组(PTX组)各32例.对照组采用常规治疗,PTX组患者在此基础上加用己酮可可碱注射液200 mg,每日2次.观察两组患者治疗效果、血气分析指标及血清中肿瘤坏死因子α(TNF-α)、白细胞介素8(IL-8)含量变化.结果 治疗后3、7 d两组患者动脉血氧分压(PaO_2)、氧合指数(PaO_2/FiO_2)差异有统计学意义(P＜0.05),PTX组血清TNF-α、IL-8及病死率均低于对照组(P＜0.05).结论 PTX联合机械通气治疗能够有效阻抑ARDS患者的炎性反应,改善患者氧合情况和预后.%Objective To explorer the clinical effects of Pentoxifylline(PTX group) with mechanical ventilation in patients with acute respiratory distress syndrome(ARDS). Methods 64 patients with ARDS were randomized into a control group(n = 32 ,ARDS conventional treatment) and a PTX group(n = 32 ,PTX 50ml iv bid in addition to the conventional treatment). The patients were closely monitored with their curative effect, blood gas indexes and serum levels of TNF-α and IL-8 after the treatment. Results The PaO_2 and PaO_2/FiO_2 got significantly higher in the PTX group than in the control group on 3d and 7d (P ＜ 0.05). The serum levels of TNF-α and IL-8 and the mortality of ARDS were significantly decreased in the PTX group after the combined with Pentoxifylline (P ＜ 0.05 or P ＜0.01). Conclusion The treatment combined with the Pentoxifylline can effectively improve the Oxygenation and prognosis of ARDS patients by inhibiting the inflammatory responses.

摘要： Objective To investigate the expression and location of caveolin-1 (Cav-1), aquaporin 1 ( AQP1 ) and AQP5 in the lung of acute pancreatitis-associated lung injury rats and to determine the role of these molecules in the pathologic progress and the potential therapeutic mechanisms of Qingyitang. Methods Forty Wistar rats were randomly divided into sham operation (SHAM) group, acute lung injury (ALI)group, dexamethasone (DEX) group and Qingyitang (QYT) group. ALI was induced by reverse injection of deoxycholate into biliopancreatic duct of rats. Blood and lung tissues were collected after 24 h. Serum amylase, lung wet/dry (W/D) ratio and pathological section were detected to evaluate the degree of lung injury. reverse transcription-polymerase chain reaction was taken to detect the mRNA levels of Cav-1, AQP1 and AQP5. Lipid rafts were prepared for detection of the distribution and expression level of Cav-1, AQP1 and AQP5 proteins by Western blot. Results The concentration of serum amylase, the value of W/D and the degree of pathological lung injury obviously increased in ALI rats. Cav-1, AQP1 and AQP5 were present in the lung while the mRNA level decreased in ALI rats. Cav-1 appeared mainly in lipid rafts and less in non-lipid rafts. AQP1 was localized to lipid rafts while AQP5 to non-lipid rafts. The localization of these three molecules in the lung of ALI rats did not change compared with SHAM rats while their protein levels decreased. Compared with ALI rats, the concentration of serum amylase, the value of W/D and the degree of pathological lung injury obviously decreased in DEX and QYT rats. The mRNA and the protein expression of Cay-1, AQP1 and AQP5 increased in various degrees by DEX or QYT treatment. Conclusion Cav-1 and AQP1 are enriched in lipid rafts while AQP5 in non-lipid rafts. The down-regulated expression of these three molecules may play important role in acute pancreatitis-associated lung injury. DEX and QYT may relieve lung injury effectively by up-regulating the expressions of Cav-1, AQP1 and AQP5.%目的 观察窖蛋白(Cav)1和水通道蛋白(AQP)1、5在急性胰腺炎肺损伤大鼠肺组织中的表达及定位,探讨其在急性胰腺炎肺损伤发病过程中的作用及清胰汤的可能作用机制.方法 将40只Wistar大鼠分为假手术组、模型组、地塞米松治疗组、清胰汤治疗组.经胰胆管逆行注射脱氧胆酸钠建立大鼠急性胰腺炎肺损伤模型.24 h后采血和肺组织,检测血清淀粉酶、肺湿/干重比值和肺组织病理切片判定损伤程度;RT-PCR检测肺组织中Cav-1和AQP1、AQP5的mRNA表达;提取脂筏,Western印迹检测Cav-1和AQP1、AQP5在脂筏内外的定位与表达.结果 模型组大鼠血清淀粉酶[(6152±502)U/L]、肺湿/干重比值(7.98±0.41)和肺组织病理损伤程度均明显升高.肺组织Cav-1和AQP1、AQP5均有表达,但在模型组mRNA表达水平均下调.Cav-1在脂筏内外均有表达,以脂筏内为主,AQP1完全定位在脂筏上,而AQP5则定位在脂筏外,三者在脂筏内外的分布状态没有改变,但表达量在模型组均明显下降.与模型组相比,地塞米松和清胰汤治疗组大鼠血清淀粉酶、肺湿/干重比值和肺组织病理损伤程度均下降;肺组织Cav-1和AQP1、AQP5的mRNA表达上调,在脂筏内外的表达水平有不同程度的恢复.结论 Cav-1和AQP1定位在脂筏,而AQP5定位在脂筏外,三者的表达下调与急性胰腺炎肺损伤密切相关.地塞米松和清胰汤都能够明显上调Cav-1和AQP1、AQP5的表达,有效减轻肺损伤程度.

摘要： 目的 研究影响严重创伤合并急性肺损伤恶化进展为急性呼吸窘迫综合征的潜在危险因素.方法 回顾性分析严重创伤患者375例,通过单因素和多因素逻辑回归分析法对20个潜在影响急性肺损伤恶化进展的危险因素进行研究.结果 所有严重创伤合并急性肺损伤患者纳入研究,分析得出6个影响急性肺损伤进展为急性呼吸窘迫综合征的危险因素是:脓毒症、创伤持续时间、APACHE Ⅱ评分、弥漫性血管内凝血(DIC)、胃肠返流、高龄;同时发现这些特定的危险因素对不同的分层患者人群具有不同的影响程度.结论 脓毒症、DIC和创伤持续时间对急性肺损伤恶化进展为急性呼吸窘迫综合征的影响是始终贯穿于整个治疗期;胃肠返流和APACHE Ⅱ评分对病情进展的预测仅仅存在于创伤后的早期阶段;由于严重的创伤性打击和肺功能的衰退,高龄仍旧是影响急性肺损伤进展的独立危险因素.具备这些危险因素的患者必须尽可能早的接受积极治疗以阻止进一步恶化.%Objectives To investigate the potential risk factors of affecting progression from acute lung injury (ALI) to acute respiratory distress syndrome in severe trauma population. Methods Twenty potential risk factors of affecting progression of acute lung injury were examined by univariate and multivariate logistic analyses among the severe trauma patients in a retrospective study. Results All of 375 specially severe trauma patients with ALI were included for analysis. The six risk factors that affected the progression from acute lung injury to acute respiratory distress syndrome were sepsis, duration of trauma, APACHE Ⅱ score, DIC, aspiration of gastric contents, and advanced age. Specific risk factors also affected different patient subpopulations at different degrees. Conclusion Impact of sepsis, DIC and duration of trauma that predict progression of ALI exists throughout the entire treatment period while aspiration of gastric contents and APACHE Ⅱ score might affect aggravation of ALI only during the early period; due to deterioration of pulmonary function and severely traumatic injury, advanced age is still an independent risk factor; patients with these risk factors need aggressive supportive cares as early as poasible in order to prevent further aggravations.

摘要： 目的:探讨血红素加氧酶-1(HO-1)对内毒素致兔急性肺损伤(ALI)的保护作用.方法:将24只雄性新西兰白兔随机分为生理盐水对照组(A组),内毒素损伤组(B组),血晶素预处理组(C组).用内毒素(700 μg/kg)一次性静脉注射复制兔急性肺损伤模型.检测肺组织HO-1蛋白的表达情况,以及在实验前(0 h)、实验后 0.5 h、 1 h、 2 h、 4 h 各点动脉血气、血清SOD值与MDA值.结果: B组动物静脉注射内毒素 0.5 h 后,动脉血氧分压下降至最低7.287kPa(＜8kPa,符合急性肺损伤标准),血清SOD值 2 h、 4 h 时明显低于A组(P＜0.01),血清MDA值明显高于A组(P＜0.01).C组肺组织HO-1蛋白(平均光密度)明显高于A和B组(P＜0.01).结论:肺组织HO-1表达增加对内毒素所致ALI有一定的保护作用.

摘要： Objective To analyze the early risk factors of acute lung injury (ALI) following orthotopic liver transplantation (OLT). Methods Ninety-one patients with end-stage liver disease, 79 males and 12 females, underwent OLT. The general condition, serum total bilirubin, albumin, creatinine, and prothrombin activity, Child-Turcotte-Pugh(CTP) score, and model for end-stage liver disease (MELD) score 48 h before operation were recorded. The operation time, cold ischemia time of donor's liver, time of anhepatic phase, ascitic fluid, blood loss, RBC infusion amount, crystal infusion, and total infusion during operation were recorded too. Follow-up was conducted for 14 days to observe the clinical manifestation, and time of ventilatory support, arterial blood gas analysis and radiological examination of chest were performed. Univariate analysis and logistic stepwise regression analysis were done to investigate the early risk factors of ALI. Result 53 patients (58.2%) suffered from pulmonary complications following OLT, including ALI (27.5%) and adult respiratory distress syndrome (ARDS) (5.5%). Univariate analysis showed that preoperative senior age, severe hepatitis B, high serum total bilirubin, low prothrombin activity, and high CTP and MELD scores, and large amount of blood loss and RBC infusion during operation were all risk factors of ALI following OLT (all P<0.05). Logistic stepwise regression analysis screened out serum total bilirubin as an independent predictor for ALI following OLT. Conclusion A little more than a quarter of the patients undergoing OLT develop ALI after operation. High preoperative serum total bilirubin is an important early risk factor for ALI following OLT.%目的 观察原位肝移植(OLT)术后患者早期急性肺损伤(ALI)的发生情况,分析其相关的早期危险因素.方法 采用成组设计的病例-对照研究方法 .2004年11月至2006年6月中山大学附属第三医院91例接受OLT的患者,术前明确疾病种类并进行肝功能分级,术中观察并记录手术时间、出入量等指标,术后连续追踪14 d观察急性肺损伤发生情况.对各种因素进行单因素及多因素分析,多因素分析采用Logistic(Forward法)逐步回归.结果 53例术后出现呼吸系统并发症,发病率为58.2%,其中25例发生ALI,发病率为27.5%.单因素分析显示高龄、重型肝炎、术前高血清胆红素、低凝血酶原活动度、高Child及MELD评分、术中失血多、输血多是OLT术后发生ALI的高危因素(均P<0.05),Logistic逐步回归分析筛选出胆红素是影响术后ALI发生的独立的早期危险因素.结论 OLT术后早期ALI的发病率为27.5%,术前高血清胆红素是术后ALI的重要早期危险因素.

摘要： 本发明涉及一种用于治疗成人呼吸窘迫综合征的中药，它是由以下重量配比的原料药材制备而成：光叶水苏15份、毕澄茄6份、佛甲草15份、稀花蓼30份、大尾摇12份、巴掌草6份、芙蓉叶12份、象贝母9份。临床实验证明，本发明能够安全有效治疗成人呼吸窘迫综合征。

摘要： 本发明涉及神经激肽‑1(NK‑1)受体拮抗剂用于治疗脓毒症、脓毒症休克、全身炎性反应综合征(SIRS)、急性呼吸窘迫综合征(ARDS)或多器官功能障碍综合征(MODS)的新用途。本发明还涉及用于这样的用途的包含NK‑1受体拮抗剂和组合的一种或更多种治疗剂的药物组合物。

摘要： 本发明旨在开发和验证肝移植受者LT术后7天内发生急性呼吸窘迫综合征的预测模型和相关诊断试剂盒。通过回顾性提取中山大学附属第三医院大数据平台2015年1月至2020年2月接受LT的755例患者资料。利用受体年龄、BMI、MELD分数、总胆红素、凝血酶原时间、手术时间、标准尿量、总入量、红细胞输注量等9个变量来预测肝移植术后ARDS，将有望在未来的临床应用中预测肝移植受体的术后ARDS，有助于临床工作中对ARDS的早期决策。

摘要： 本发明公开一种急性呼吸窘迫综合征临床智能辅助装置，属于医疗器械技术领域，包括病床，病床的侧端设有控制器，病床上对称开设有两个开口，两个开口内分别转动连接有头部固定机构与腿部固定机构，病床的底端还设有两个支撑板，支撑板上对称设有两个第一电控气缸，两个第一电控气缸的输出端分别与头部固定机构以及腿部固定机构连接，病床的头部位置设有放置槽，放置槽内设有第二电控气缸，第二电控气缸的输出端设有弧形槽；本发明结构简单，头部固定机构与腿部固定机构的斜度可电控调节，不需要医护人员去辅助帮忙，节约医护资源，同时通过头部固定机构与腿部固定机构可对不同身材的病人进行体位固定，避免体位姿势不正确影响氧疗效果。

摘要： 本发明涉及医药研发技术领域，具体涉及一种黄酮碳苷类化合物在制备预防或治疗急性肺损伤和/或急性呼吸窘迫综合征的药物中的应用，所述黄酮碳苷类化合物具有下式所示的结构：其中，R1‑R8如本发明说明书所限定，本发明提供的黄酮碳苷类化合物能够明显抑制炎症反应，抑制炎性因子的释放，降低肺泡灌洗液和血清中的炎性因子的含量，同时还能够明显抑制肺水肿，减少肺积液的产生，降低肺脏湿重，抑制急性肺损伤导致的肺脏湿重与干重比的升高程度，从而起到在抗炎的同时抑制肺部水肿的作用。

摘要： 本发明涉及医药研发技术领域，具体涉及一种黄酮类化合物在制备预防或治疗急性肺损伤和/或急性呼吸窘迫综合征的药物中的应用，所述黄酮类化合物具有式I所示的结构：其中，选自|或者||；R1选自H、羟基、C1‑C8的烷基、C3‑C10的环烷基、C1‑C8的烷氧基和C4‑C20的糖基残基；R2和R3独立地选自H、羟基、C1‑C8的烷基、C3‑C10的环烷基和C1‑C8的烷氧基中的一种；R4选自C5‑C20的芳基或者取代的C5‑C20的芳基。上述黄酮类化合物能够明显缓解急性肺损伤小鼠的炎症反应，降低肺脏湿重与干重比，在抗炎的同时抑制急性肺部损伤导致的肺部水肿，可以作为潜在的预防或者治疗急性肺损伤的药物。

摘要： 本发明涉及医药研发技术领域，具体涉及一种黄酮衍生物在制备预防或治疗急性肺损伤和/或急性呼吸窘迫综合征的药物中的应用，所述黄酮衍生物具有式I所示的结构：其中，R1选自H、C1‑C8的烷基和C3‑C10的环烷基中的一种；R2选自C5‑C20的芳基或者取代的C5‑C20的芳基。本发明提供的黄酮衍生物能够明显抑制炎症反应，抑制炎性因子的释放，降低肺泡灌洗液和血清中的炎性因子的含量，同时还能够明显抑制肺水肿，减少肺积液的产生，降低肺脏湿重，抑制急性肺损伤导致的肺脏湿重与干重比的升高程度，从而起到在抗炎的同时抑制肺部水肿的作用。

摘要： 本发明提供一种黄酮类化合物在制备预防或治疗急性肺损伤或急性呼吸窘迫综合征的药物中用途。本发明首次提出了式(I)所示的6，7位甲氧基取代的黄酮类化合物在制备预防或治疗急性肺损伤或急性呼吸窘迫综合征的药物中用途，本发明提供的黄酮类化合物能够明显缓解急性肺损伤所导致的炎症反应，降低肺泡和血清中的炎性因子含量，减少肺积液的产生，在抗炎的同时抑制急性肺部损伤导致的肺部水肿，具有用量低、疗效显著的优点，可以作为潜在的预防或者治疗急性肺损伤的药物。由此本发明拓展了6，7位甲氧基取代的黄酮类化合物的应用领域。

摘要： 本发明涉及医药技术领域，具体涉及一种甲基黄酮类化合物在制备预防或治疗急性肺损伤和/或急性呼吸窘迫综合征药物中的应用。本发明提供的甲基黄酮类化合物具有下式所示的结构：上述的甲基黄酮类化合物能够明显抑制炎症反应，抑制炎性因子IL‑1β、IL‑6、TNF‑α及MPO的释放，降低急性肺损伤小鼠肺泡灌洗液和血清中的炎性因子含量，同时还能明显抑制肺水肿，减少肺积液的产生，降低肺脏湿重，抑制急性肺损伤导致的肺脏湿重与干重比的升高程度，从而起到在抗炎的同时抑制肺部水肿的作用，可有效减少肺部急性炎性损伤、推迟或减弱呼吸窘迫的出现，缓解重型和危重型患者症状，可用于预防或者治疗急性肺损伤的药物。

摘要： 本发明涉及医药研发技术领域，具体涉及一种杂环黄酮类化合物在制备预防或治疗急性肺损伤和/或急性呼吸窘迫综合征的药物中的应用，其特征在于，所述杂环黄酮类化合物具有式I所示的结构：其中，R1、R3、R4、R5独立地选自H、C1‑C8的烷基、C3‑C10的环烷基和C1‑C8的烷氧基中的一种；R2选自H、C1‑C8的烷基、C3‑C10的环烷基和C1‑C8的酰基中的一种。本发明提供的杂环黄酮类化合物能够明显缓解急性肺损伤小鼠的炎症反应，降低炎性因子含量，降低肺脏湿重与干重比，在抗炎的同时抑制急性肺部损伤导致的肺部水肿，具有用量低、疗效显著的优点，可以作为潜在的预防或者治疗急性肺损伤的药物。