急性呼吸窘迫综合征抗炎治疗中中性粒细胞弹性蛋白酶抑制剂急诊应用专家共识

文章来源：中国知网

摘要：推荐意见 1 ：对于 ARDS 患者，应当在诊断的同时评估氧合状况用以指导抗炎药物使用，推荐标准治疗基础上早期（至少 48 h 内）联合应用西维来司他钠。（证据级别：中等质量；推荐级别：强推荐）推荐意见 2 ：推荐 ARDS 患者同步检测 IL-6 等炎症因子以评估炎症水平，高炎症表型 ARDS 患者中使用西维来司他钠等抗炎药物可能有效。（证据级别：低质量；推荐级别：弱推荐）推荐意见 3 ：对于存在 ARDS 高危因素的低氧血症患者应用西维来司他钠可早期改善氧合。（证据级别：低质量；推荐级别：弱推荐）推荐意见 4 ：ARDS 患者中可尝试西维来司他钠与其他抗炎药物联合治疗，可能通过多途径抑制炎症带来获益。（证据级别：低质量；推荐级别：弱推荐）推荐意见 5 ：对于脓毒症并发 ARDS 的患者，可参考西维来司他钠在 ARDS 患者中的应用。（证据级别：中等质量；推荐级别：强推荐）推荐意见 6 ：脓毒症患者即使未并发 ARDS，应用西维来司他钠可能有潜在心、肺及肠道等器官功能保护作用。（证据级别：低质量；推荐级别：弱推荐）推荐意见 7 ：急性中毒患者应尽量明确中毒机制，对于靶器官为肺或合并其他 ARDS 高危因素的患者可以在常规治疗基础上联合应用西维来司他钠等抗炎药物。（证据级别极低质量；推荐级别：弱推荐）推荐意见 8 ：创伤合并高炎症状态患者可继发 ARDS及其他多器官功能障碍，对于此类患者或创伤性湿肺患者应用西维来司他钠可能有潜在获益。（证据级别：低质量；推荐级别：弱推荐）

标签： ALI/ARDS

查看数：97

发布时间：2025-04-08 邹文成

公开

中华医学会急诊医学分会广东省医师协会急诊医师分会通信作者：李欣，Email: sylixin@scut.edu.cn.；张国强，Email: zhangchong2003@vip. sina.com；马岳峰，Email: 2193017@zju.edu.cn DOI:10.3760/cma.j.issn.1671-0282.2025.04.002

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附件1: 急性呼吸窘迫综合征抗炎治疗中中性粒细胞弹性蛋白酶抑制剂急诊应用专家共识.pdf 下载附件

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[ SQL ] SHOW COLUMNS FROM `zitu_plugin` [ RunTime:0.000808s ]
[ SQL ] SELECT `config` FROM `zitu_plugin` WHERE `name` = 'TcSwitchTheme' LIMIT 1 [ RunTime:0.000323s ]
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[ SQL ] SHOW COLUMNS FROM `zitu_hits_log` [ RunTime:0.000703s ]
[ SQL ] INSERT INTO `zitu_hits_log` (`ip` , `create_time`) VALUES ('216.73.216.8' , 1750856703) [ RunTime:0.021054s ]
[ SQL ] SHOW COLUMNS FROM `zitu_portal_post` [ RunTime:0.001101s ]
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[ SQL ] SELECT `post`.* FROM `zitu_portal_post` `post` INNER JOIN `zitu_portal_category_post` `relation` ON `post`.`id`=`relation`.`post_id` WHERE `post`.`post_type` = 1 AND `post`.`post_status` = 1 AND `post`.`delete_time` = 0 AND `relation`.`category_id` = 7 AND `relation`.`post_id` < 918 AND ( `post`.`published_time` > 0 AND `post`.`published_time` < 1750856703 ) ORDER BY `id` DESC LIMIT 1 [ RunTime:0.005173s ]
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[ SQL ] SELECT `post`.* FROM `zitu_portal_post` `post` INNER JOIN `zitu_portal_category_post` `relation` ON `post`.`id`=`relation`.`post_id` WHERE `post`.`post_type` = 1 AND `post`.`post_status` = 1 AND `post`.`delete_time` = 0 AND `relation`.`category_id` = 7 AND `relation`.`post_id` > 918 AND ( `post`.`published_time` > 0 AND `post`.`published_time` < 1750856703 ) ORDER BY `id` ASC LIMIT 1 [ RunTime:0.000671s ]
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[ SQL ] SHOW COLUMNS FROM `zitu_portal_category` [ RunTime:0.002780s ]
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[ SQL ] UPDATE `zitu_portal_post` SET `post_hits` = `post_hits` + 1 WHERE `id` = 918 [ RunTime:0.021751s ]
[ SQL ] SHOW COLUMNS FROM `zitu_portal_category_post` [ RunTime:0.000791s ]
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[ SQL ] SELECT * FROM `zitu_portal_category` WHERE `id` IN (1,3,4,12,2,7,10,56,57,147,59,68,76,77,69,70) ORDER BY CHAR_LENGTH(path) ASC [ RunTime:0.000402s ]
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[ SQL ] SHOW COLUMNS FROM `zitu_user_preview` [ RunTime:0.000972s ]
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[ SQL ] SHOW COLUMNS FROM `zitu_theme_file` [ RunTime:0.001052s ]
[ SQL ] SELECT * FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' AND `file` = 'portal/article' LIMIT 1 [ RunTime:0.000497s ]
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[ SQL ] UPDATE `zitu_theme_file` SET `theme` = 'simpleboot3' , `action` = 'portal/Article/index' , `file` = 'portal/article' , `name` = '文章页' , `more` = '{\"vars\":{\"hot_articles_category_id\":{\"title\":\"Hot Articles\\u5206\\u7c7bID\",\"value\":\"1\",\"type\":\"text\",\"tip\":\"\",\"rule\":[]}}}' , `config_more` = '{\"vars\":{\"hot_articles_category_id\":{\"title\":\"Hot Articles\\u5206\\u7c7bID\",\"value\":\"1\",\"type\":\"text\",\"tip\":\"\",\"rule\":[]}}}' , `description` = '文章页模板文件' , `is_public` = 0 , `list_order` = 10 WHERE `theme` = 'simpleboot3' AND `file` = 'portal/article' [ RunTime:0.025101s ]
[ SQL ] SELECT * FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' AND `file` = 'portal/index' LIMIT 1 [ RunTime:0.000606s ]
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[ SQL ] UPDATE `zitu_theme_file` SET `theme` = 'simpleboot3' , `action` = 'portal/Index/index' , `file` = 'portal/index' , `name` = '首页' , `more` = '{\"vars\":[],\"widgets\":{\"product_category_list\":{\"title\":\"\\u5206\\u7c7b\\u5217\\u8868\",\"display\":1,\"vars\":{\"product_category_list_id\":{\"title\":\"\\u5206\\u7c7b\\u5217\\u8868\",\"value\":\"1,3,4,12,13,8,31,32,48,49,123,9,50,51,52,53,54,33,35,36,37,38,39,40,34,41,42,43,44,45,46,47,55,14,15,16,17,18,118,56,57,58,59,60\",\"type\":\"text\",\"dataSource\":{\"api\":\"portal\\/category\\/index\",\"multi\":true},\"placeholder\":\"\\u5206\\u7c7b\\u5217\\u8868\",\"tip\":\"\",\"rule\":{\"require\":true},\"valueText\":\"\\u533b\\u5b66\\u4fe1\\u606f,\\u6307\\u5357\\u5171\\u8bc6,\\u5faa\\u8bc1\\u8bc1\\u636e,\\u63a8\\u8350\\u89c2\\u70b9,\\u4e34\\u5e8a\\u9879\\u76ee,\\u5b81\\u6ccc\\u6cf0\\u80f6\\u56ca,\\u6162\\u6027\\u524d\\u5217\\u817a\\u708e,\\u6ccc\\u5c3f\\u7cfb\\u611f\\u67d3,\\u6ccc\\u5c3f\\u7cfb\\u7ed3\\u77f3,\\u5b81\\u6ccc\\u6cf0\\u9002\\u7528\\u7684\\u5176\\u4ed6\\u76f8\\u5173\\u75be\\u75c5,\\u826f\\u6027\\u524d\\u5217\\u817a\\u589e\\u751f,\\u590f\\u67af\\u8349\\u53e3\\u670d\\u6db2,\\u7532\\u72b6\\u817a\\u7ed3\\u8282,\\u6865\\u672c\\u7532\\u72b6\\u817a\\u708e,Graves\\u75c5,\\u4e73\\u817a\\u589e\\u751f\\/\\u4e73\\u817a\\u708e,\\u590f\\u67af\\u8349\\u9002\\u7528\\u7684\\u5176\\u4ed6\\u76f8\\u5173\\u75be\\u75c5,\\u82e6\\u53c2\\u51dd\\u80f6,\\u7ec6\\u83cc\\u6027\\u9634\\u9053\\u75c5\\uff08BV\\uff09,\\u5916\\u9634\\u9634\\u9053\\u5047\\u4e1d\\u9175\\u6bcd\\u83cc\\u75c5\\uff08VVC\\uff09,\\u4eba\\u4e73\\u5934\\u7624\\u75c5\\u6bd2\\u611f\\u67d3\\uff08HPV\\uff09,\\u840e\\u7f29\\u6027\\u9634\\u9053\\u708e,\\u6df7\\u5408\\u6027\\u9634\\u9053\\u708e,\\u82e6\\u53c2\\u51dd\\u80f6\\u9002\\u7528\\u7684\\u5176\\u4ed6\\u76f8\\u5173\\u75be\\u75c5,\\u5764\\u6cf0\\u80f6\\u56ca,\\u7edd\\u7ecf\\u7efc\\u5408\\u5f81,\\u5375\\u5de2\\u50a8\\u5907\\u529f\\u80fd\\u51cf\\u9000\\uff08DOR\\uff09,GnRHa\\u4f4e\\u96cc\\u75c7\\u72b6,\\u5375\\u5de2\\u529f\\u80fd\\u8870\\u9000\\u5931\\u7720\\u7126\\u8651,\\u65e9\\u53d1\\u6027\\u5375\\u5de2\\u529f\\u80fd\\u4e0d\\u5168\\uff08POI\\uff09,\\u5375\\u5de2\\u65e9\\u8870\\uff08POF\\uff09,\\u591a\\u56ca\\u5375\\u5de2\\u7efc\\u5408\\u5f81\\uff08PCOS\\uff09,\\u5764\\u6cf0\\u80f6\\u56ca\\u9002\\u7528\\u7684\\u5176\\u4ed6\\u76f8\\u5173\\u75be\\u75c5,\\u5e02\\u573a\\u6750\\u6599,\\u5e94\\u7528\\u573a\\u666f,\\u63a8\\u8350\\u89c2\\u70b9,\\u5e02\\u573a\\u6d3b\\u52a8,\\u7eff\\u5361,\\u4e8b\\u4e1a\\u90e8\\u533b\\u5b66\\u652f\\u6301,\\u79d1\\u5ba4\\u53ca\\u533b\\u62a4\\u4eba\\u5458,\\u5185\\u79d1,\\u5916\\u79d1,\\u91cd\\u70b9\\u79d1\\u5ba4,\\u533b\\u62a4\\u7fa4\\u4f53\"}}}}}' , `config_more` = '{\"vars\":[],\"widgets\":{\"product_category_list\":{\"title\":\"\\u5206\\u7c7b\\u5217\\u8868\",\"display\":\"1\",\"vars\":{\"product_category_list_id\":{\"title\":\"\\u5206\\u7c7b\\u5217\\u8868\",\"value\":\"\",\"type\":\"text\",\"dataSource\":{\"api\":\"portal\\/category\\/index\",\"multi\":true},\"placeholder\":\"\\u5206\\u7c7b\\u5217\\u8868\",\"tip\":\"\",\"rule\":{\"require\":true}}}}}}' , `description` = '首页模板文件' , `is_public` = 0 , `list_order` = 5 WHERE `theme` = 'simpleboot3' AND `file` = 'portal/index' [ RunTime:0.036123s ]
[ SQL ] SELECT * FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' AND `file` = 'portal/list' LIMIT 1 [ RunTime:0.000698s ]
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[ SQL ] UPDATE `zitu_theme_file` SET `theme` = 'simpleboot3' , `action` = 'portal/List/index' , `file` = 'portal/list' , `name` = '文章列表页' , `more` = '[]' , `config_more` = '[]' , `description` = '文章列表模板文件' , `is_public` = 0 , `list_order` = 10 WHERE `theme` = 'simpleboot3' AND `file` = 'portal/list' [ RunTime:0.038912s ]
[ SQL ] SELECT * FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' AND `file` = 'portal/page-about' LIMIT 1 [ RunTime:0.000438s ]
[ EXPLAIN : array ( 'id' => 1, 'select_type' => 'SIMPLE', 'table' => 'zitu_theme_file', 'type' => 'ALL', 'possible_keys' => NULL, 'key' => NULL, 'key_len' => NULL, 'ref' => NULL, 'rows' => 18, 'extra' => 'Using where', ) ]
[ SQL ] UPDATE `zitu_theme_file` SET `theme` = 'simpleboot3' , `action` = 'portal/Page/index' , `file` = 'portal/page-about' , `name` = '关于我们单页面' , `more` = '[]' , `config_more` = '[]' , `description` = '单页面模板文件' , `is_public` = 0 , `list_order` = 10 WHERE `theme` = 'simpleboot3' AND `file` = 'portal/page-about' [ RunTime:0.037206s ]
[ SQL ] SELECT * FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' AND `file` = 'portal/page-contact' LIMIT 1 [ RunTime:0.000489s ]
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[ SQL ] UPDATE `zitu_theme_file` SET `theme` = 'simpleboot3' , `action` = 'portal/Page/index' , `file` = 'portal/page-contact' , `name` = '联系我们' , `more` = '[]' , `config_more` = '[]' , `description` = '单页面模板文件' , `is_public` = 0 , `list_order` = 10 WHERE `theme` = 'simpleboot3' AND `file` = 'portal/page-contact' [ RunTime:0.032763s ]
[ SQL ] SELECT * FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' AND `file` = 'portal/page' LIMIT 1 [ RunTime:0.000373s ]
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[ SQL ] UPDATE `zitu_theme_file` SET `theme` = 'simpleboot3' , `action` = 'portal/Page/index' , `file` = 'portal/page' , `name` = 'page页面' , `more` = '[]' , `config_more` = '[]' , `description` = '单页面模板文件' , `is_public` = 0 , `list_order` = 10 WHERE `theme` = 'simpleboot3' AND `file` = 'portal/page' [ RunTime:0.037777s ]
[ SQL ] SELECT * FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' AND `file` = 'portal/search' LIMIT 1 [ RunTime:0.000372s ]
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[ SQL ] UPDATE `zitu_theme_file` SET `theme` = 'simpleboot3' , `action` = 'portal/Search/index' , `file` = 'portal/search' , `name` = '搜索页面' , `more` = '[]' , `config_more` = '[]' , `description` = '搜索模板文件' , `is_public` = 0 , `list_order` = 10 WHERE `theme` = 'simpleboot3' AND `file` = 'portal/search' [ RunTime:0.042071s ]
[ SQL ] SELECT * FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' AND `file` = 'public/config' LIMIT 1 [ RunTime:0.000383s ]
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[ SQL ] UPDATE `zitu_theme_file` SET `theme` = 'simpleboot3' , `action` = 'public/Config' , `file` = 'public/config' , `name` = '模板全局配置' , `more` = '{\"vars\":{\"enable_mobile\":{\"title\":\"\\u624b\\u673a\\u6ce8\\u518c\",\"value\":1,\"type\":\"select\",\"options\":{\"1\":\"\\u5f00\\u542f\",\"0\":\"\\u5173\\u95ed\"},\"tip\":\"\"}}}' , `config_more` = '{\"vars\":{\"enable_mobile\":{\"title\":\"\\u624b\\u673a\\u6ce8\\u518c\",\"value\":1,\"type\":\"select\",\"options\":{\"1\":\"\\u5f00\\u542f\",\"0\":\"\\u5173\\u95ed\"},\"tip\":\"\"}}}' , `description` = '模板全局配置文件' , `is_public` = 1 , `list_order` = 0 WHERE `theme` = 'simpleboot3' AND `file` = 'public/config' [ RunTime:0.038594s ]
[ SQL ] SELECT * FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' AND `file` = 'public/nav' LIMIT 1 [ RunTime:0.000409s ]
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[ SQL ] UPDATE `zitu_theme_file` SET `theme` = 'simpleboot3' , `action` = 'public/Nav' , `file` = 'public/nav' , `name` = '导航条' , `more` = '{\"vars\":{\"company_name\":{\"title\":\"\\u516c\\u53f8\\u540d\\u79f0\",\"name\":\"company_name\",\"value\":\"ThinkCMF\",\"type\":\"text\",\"tip\":\"\",\"rule\":[]}}}' , `config_more` = '{\"vars\":{\"company_name\":{\"title\":\"\\u516c\\u53f8\\u540d\\u79f0\",\"name\":\"company_name\",\"value\":\"ThinkCMF\",\"type\":\"text\",\"tip\":\"\",\"rule\":[]}}}' , `description` = '导航条模板文件' , `is_public` = 1 , `list_order` = 1 WHERE `theme` = 'simpleboot3' AND `file` = 'public/nav' [ RunTime:0.021806s ]
[ SQL ] SELECT * FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' [ RunTime:0.000373s ]
[ EXPLAIN : array ( 'id' => 1, 'select_type' => 'SIMPLE', 'table' => 'zitu_theme_file', 'type' => 'ALL', 'possible_keys' => NULL, 'key' => NULL, 'key_len' => NULL, 'ref' => NULL, 'rows' => 18, 'extra' => 'Using where', ) ]
[ SQL ] SHOW COLUMNS FROM `zitu_theme` [ RunTime:0.000979s ]
[ SQL ] UPDATE `zitu_theme` SET `name` = 'simpleboot3' , `version` = '1.0.2' , `demo_url` = 'https://www.zeotrue.com' , `author` = 'zitu' , `lang` = 'zh-cn' , `author_url` = 'https://www.zeotrue.com' , `keywords` = 'PC端模板' , `description` = 'PC端默认模板' WHERE `theme` = 'simpleboot3' [ RunTime:0.032097s ]
[ SQL ] SELECT `more` FROM `zitu_theme_file` WHERE `theme` = 'simpleboot3' AND ( `is_public` = 1 OR `file` = 'portal/article' ) [ RunTime:0.000388s ]
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[ SQL ] SHOW COLUMNS FROM `zitu_portal_tag_post` [ RunTime:0.000822s ]
[ SQL ] SHOW COLUMNS FROM `zitu_portal_tag` [ RunTime:0.000674s ]
[ SQL ] SELECT `zitu_portal_tag`.*,`pivot`.`id` AS `pivot__id`,`pivot`.`tag_id` AS `pivot__tag_id`,`pivot`.`post_id` AS `pivot__post_id`,`pivot`.`status` AS `pivot__status` FROM `zitu_portal_tag` INNER JOIN `zitu_portal_tag_post` `pivot` ON `pivot`.`tag_id`=`zitu_portal_tag`.`id` WHERE `pivot`.`post_id` = 918 [ RunTime:0.000314s ]
[ EXPLAIN : array ( 'id' => 1, 'select_type' => 'SIMPLE', 'table' => 'pivot', 'type' => 'ref', 'possible_keys' => 'post_id,tag_id,post_id_2,tag_id_2,post_id_3', 'key' => 'post_id', 'key_len' => '8', 'ref' => 'const', 'rows' => 1, 'extra' => '', ) ]
[ SQL ] SHOW COLUMNS FROM `zitu_nav_menu` [ RunTime:0.000736s ]
[ SQL ] SELECT * FROM `zitu_nav_menu` WHERE `nav_id` = 1 AND `status` = 1 ORDER BY `list_order` ASC [ RunTime:0.000274s ]
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[ SQL ] SHOW COLUMNS FROM `zitu_user` [ RunTime:0.000797s ]
[ SQL ] SELECT * FROM `zitu_user` WHERE `id` = 2102 LIMIT 1 [ RunTime:0.000291s ]
[ EXPLAIN : array ( 'id' => 1, 'select_type' => 'SIMPLE', 'table' => 'zitu_user', 'type' => 'const', 'possible_keys' => 'PRIMARY', 'key' => 'PRIMARY', 'key_len' => '8', 'ref' => 'const', 'rows' => 1, 'extra' => '', ) ]
[ SQL ] SHOW COLUMNS FROM `zitu_option` [ RunTime:0.000697s ]
[ SQL ] SELECT `option_value` FROM `zitu_option` WHERE `option_name` = 'storage' LIMIT 1 [ RunTime:0.000227s ]
[ EXPLAIN : array ( 'id' => 1, 'select_type' => 'SIMPLE', 'table' => NULL, 'type' => NULL, 'possible_keys' => NULL, 'key' => NULL, 'key_len' => NULL, 'ref' => NULL, 'rows' => NULL, 'extra' => 'Impossible WHERE noticed after reading const tables', ) ]
[ SQL ] SELECT `config` FROM `zitu_plugin` WHERE `name` = 'Comment' LIMIT 1 [ RunTime:0.000271s ]
[ EXPLAIN : array ( 'id' => 1, 'select_type' => 'SIMPLE', 'table' => 'zitu_plugin', 'type' => 'ALL', 'possible_keys' => NULL, 'key' => NULL, 'key_len' => NULL, 'ref' => NULL, 'rows' => 3, 'extra' => 'Using where', ) ]
[ SQL ] SHOW COLUMNS FROM `zitu_comment` [ RunTime:0.001265s ]
[ SQL ] SELECT COUNT(*) AS tp_count FROM `zitu_comment` WHERE `object_id` = 918 AND `status` = 1 AND `delete_time` = 0 [ RunTime:0.000311s ]
[ EXPLAIN : array ( 'id' => 1, 'select_type' => 'SIMPLE', 'table' => 'zitu_comment', 'type' => 'ref', 'possible_keys' => 'object_id,status', 'key' => 'object_id', 'key_len' => '4', 'ref' => 'const', 'rows' => 1, 'extra' => 'Using where', ) ]
[ SQL ] SELECT * FROM `zitu_comment` WHERE `object_id` = 918 AND `status` = 1 AND `delete_time` = 0 ORDER BY `id` DESC LIMIT 0,15 [ RunTime:0.000287s ]
[ EXPLAIN : array ( 'id' => 1, 'select_type' => 'SIMPLE', 'table' => 'zitu_comment', 'type' => 'ref', 'possible_keys' => 'object_id,status', 'key' => 'object_id', 'key_len' => '4', 'ref' => 'const', 'rows' => 1, 'extra' => 'Using where', ) ]
[ SQL ] SELECT `post`.* FROM `zitu_portal_post` `post` INNER JOIN `zitu_portal_category_post` `category_post0` ON `post`.`id`=category_post0.post_id AND category_post0.category_id = 1 WHERE `post`.`post_status` = 1 AND `post`.`post_type` = 1 AND `post`.`delete_time` = 0 AND `is_open` = 1 AND ( `post`.`published_time` > 0 AND `post`.`published_time` < 1750856703 ) GROUP BY `post`.`id` ORDER BY `post`.`post_hits` DESC LIMIT 10 [ RunTime:0.000530s ]
[ EXPLAIN : array ( 'id' => 1, 'select_type' => 'SIMPLE', 'table' => 'category_post0', 'type' => 'ref', 'possible_keys' => 'term_taxonomy_id,post_id,category_id', 'key' => 'term_taxonomy_id', 'key_len' => '8', 'ref' => 'const', 'rows' => 648, 'extra' => 'Using temporary; Using filesort', ) ]
[ SQL ] SELECT `post`.* FROM `zitu_portal_post` `post` WHERE `post`.`post_status` = 1 AND `post`.`post_type` = 1 AND `post`.`delete_time` = 0 AND `is_open` = 1 AND ( `post`.`published_time` > 0 AND `post`.`published_time` < 1750856703 ) GROUP BY `post`.`id` ORDER BY `post`.`post_hits` DESC LIMIT 10 [ RunTime:0.000508s ]
[ EXPLAIN : array ( 'id' => 1, 'select_type' => 'SIMPLE', 'table' => 'post', 'type' => 'ref', 'possible_keys' => 'type_status_date', 'key' => 'type_status_date', 'key_len' => '2', 'ref' => 'const,const', 'rows' => 912, 'extra' => 'Using where; Using filesort', ) ]

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