文章来源：PubMed

摘要信息：Background. Since the 2012 Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS), several developments have supported the need for an expansion of the definition, including the use of high flow nasal oxygen (HFNO), expanding use of pulse oximetry in place of arterial blood gases, use of ultrasound for chest imaging, and the need for applicability in resource-limited settings. Methods. A Consensus Conference of 32 critical care ARDS experts was convened, had six virtual meetings (June 2021-March 2022), and subsequently obtained input from members of several critical care societies. The goal was to develop a definition that would: (1) identify patients with the currently accepted conceptual framework for ARDS; (2) facilitate rapid ARDS diagnosis for clinical care and research; (3) be applicable in resource-limited settings; (4) be useful for testing specific therapies; and (5) be practical for communication to patients and caregivers. Results. The committee made four main recommendations: (1) Include HFNO with a minimum flow rate of  30 liters/min; (2) Use arterial oxygen tension (PaO2)/FiO2  300 mmHg or SpO2/FiO2 < 315 (if SpO2  97%) to identify hypoxemia; (3) Retain bilateral opacities for imaging criteria but add ultrasound as an imaging modality, especially in resource-limited areas; and (4) In resource-limited settings, do not require PEEP, oxygen flow rate, or specific respiratory support devices. Conclusions. We propose a New Global Definition of ARDS that builds on the Berlin Definition. The recommendations also identify areas for future research, including the need for prospective assessments of feasibility, reliability, and prognostic validity of the proposed Global Definition.

文章来源：PubMed

摘要信息：Objective:We aimed to evaluate the protective effects of sivelestat sodium on the basis of corticosteroid therapy in patients with moderate-to-severe acute respiratory distress syndrome (ARDS).Methods:We retrospectively investigated 127 patients with confirmed moderate-to-severe ARDS treated in the intensive care unit (ICU) at Dazhou Central Hospital. Patients were divided into the control group (corticosteroids alone) and the combination therapy of steroids and sivelestat sodium (CTSSS) group according to the therapeutic interventions. The primary outcome was in-hospital mortality. And the baseline characteristics and laboratory findings of patients were collected for analysis.Results:The overall mortality rate in 127 patients was 48.8%. There was no statistically significant difference in in-hospital mortality between the CTSSS group and the control group (45.3% vs. 56.1%). In the subgroup of patients aged < 80 years or with an Acute Physiology and Chronic Health Evaluation (APACHE) II score < 30, CTSSS could reduce the risk of mortality (odds ratio [OR] = 0.41, 95% confidence interval [CI], 0.17-0.96, p=0.041; OR = 0.31, 95% CI, 0.13-0.77, p=0.012; respectively). Among patients aged 80 years or older, those with CTSSS exhibited a significantly elevated risk of mortality (OR = 13; 95% CI, 1.20-140.73; p=0.035).Conclusion:Compared with corticosteroids alone, CTSSS could improve oxygenation index, increase lymphocyte count, protect extrapulmonary organs and reduce in-hospital mortality rate in patients with moderate-to-severe ARDS in specific subgroups (age < 80 years or APACHE II score < 30). It might be advisable to avoid CTSSS in moderate-to-severe ARDS patients aged 80 years or older. Prospective studies involving larger sample sizes are needed to verify these findings.

摘要信息：研究名称：西维来司他钠对颅脑损伤后合并 ARDS 患者的⼀项多中⼼、前瞻性、双盲、随机对照试验 研究目的：通过多中⼼、前瞻性、双盲、随机对照研究，探讨西维来司他钠治疗颅脑损伤合并 ARDS 患者对疗效指标的改善、预后、安全性及药物经 济学研究。 试验设计：多中⼼、前瞻性、双盲、随机对照研究； 样本量：本研究计划按照试验组:对照组=1:1抽样，计划纳入试验组(注射用西维来司他钠)27例受试者，对照组(安慰剂)27例受试者，共计 54 例； 纳入标准：(1)年龄>18岁且<75 岁，性别不限;(2)影像学检查提示幕上部分颅脑损伤，包括脑挫裂伤、脑内血肿、硬膜下血肿及硬膜外血肿等类型(3)GCS≤12分(详见附件 5);(4)符合 ARDS全球新定义(详见附件1);(5)发病<24h; (6)连续接受试验用药>5 天:(7)受试者或家属对本次试验目的和意义有充分了解，自愿参加本次临床试验，并签署知情同意书。 排除标准： (1)妊娠或哺乳期⼥性； (2)预期⽣存＜48h； (3)脑动脉 CTA 提⽰颅内动脉瘤的； (4)合并慢性呼吸系统疾病（包括但不限于慢性阻塞性肺疾病、慢性肺(1)妊娠或哺乳期⼥性； (2)预期⽣存＜48h； (3)脑动脉 CTA 提⽰颅内动脉瘤的； (4)合并慢性呼吸系统疾病（包括但不限于慢性阻塞性肺疾病、慢性肺(1)妊娠或哺乳期⼥性； (2)预期⽣存＜48h； (3)脑动脉 CTA 提⽰颅内动脉瘤的； (4)合并慢性呼吸系统疾病（包括但不限于慢性阻塞性肺疾病、慢性肺(1)妊娠或哺乳期⼥性； (2)预期⽣存＜48h； (3)脑动脉 CTA 提⽰颅内动脉瘤的； (4)合并慢性呼吸系统疾病（包括但不限于慢性阻塞性肺疾病、慢性肺⽓肿等） (5)合并凝⾎功能障碍及颅内肿瘤者； (6)进⾏ CRRT 治疗的受试者； (7)其他终末期疾病； (8)已知对西维来司他钠或辅料、对检查时涉及的其他物质过敏者； (9)与其他对中性粒细胞弹性蛋⽩酶具有影响的药物合⽤（乌司他丁、 ⾎必净等）； (10) 经研究者判断不适合参加此试验者 1. 终点指标 主要终点指标：使⽤西维来司他钠疗程 7 天结束氧合指数改善率 次要终点指标：  脑功能指标：⼊组第 0、1、3、5、7 天（未⾜ 7 天则记录转出监 护室前最后⼀天）：GCS 评分、颅内压、脑灌注压、静脉⾎及脑 脊液中 NSE 含量；  综合指标：⼊组第 0、1、3、5、7 天（未⾜ 7 天则记录转出监护 室前最后⼀天）：D-⼆聚体、PCT、CRP、WBC、⾎⼩板计数、 NLR、静脉⾎及脑脊液中炎症因⼦⽔平（IL-1、IL-6、IL-8、IL-10） 和中性粒细胞弹性蛋⽩酶（NE）含量；SOFA 评分（详⻅附件 2）、 Murray 肺损伤评分（详⻅附件 3）、APACHE II 评分（详⻅附件 4）；  随访指标：脑室引流时⻓（h）；总住院时⻓（h）；ICU 住院时 ⻓（h）；⽓管切开发⽣率；28 天⾮机械通⽓时间（h）；预后情 况（恢复良好、中度残疾、重度残疾、植物⽣存、死亡）；  药物经济学：ICU 住院费⽤、总住院费⽤。 2. 安全性指标 （1）⽣命体征：⼼率、⾎压（SBP/DBP）、呼吸频率、氧饱和度和 体温； （2）实验室检查：⾎常规、肝肾功能、凝⾎功能、动脉⾎⽓分析、⾎ 乳酸等； （3）胸⽚或胸部 CT 检查； （4）并发症（包括但不限于压⼒性损伤、消化道出⾎、颅内感染、肺 部感染、PTSD、泌尿系统感染） （5）不良事件

摘要信息：研究目的： 明确西维来司他钠治疗伴有SIRS的轻中度ARDS的有效性及安全性。 研究内容 本研究通过计算机随机，将伴有SIRS的轻中度ARDS患者随机分为安慰剂组和西维来司他钠组, 观察两组患者入组时(D0), 第1(D1)，3(D3)，5(D5)天氧合指数(PaO2/FiO2)，呼吸频率，28天内有创机械通气率、无机械通气时间、住ICU时间、住院时间、ICU获得性感染发生率、28天全因病死率、ICU病死率等，以评价西维来司他钠治疗伴有SIRS的轻中度ARDS患者肺损伤的效果，以期改善轻中度ARDS患者氧合、增加无机械通气时间、降低ARDS病死率。 纳入标准： (1)18岁≤年龄≤75岁成年病人，其种族、国籍、性别不限； (2)研究符合赫尔辛基宣言及中国临床试验研究法规，病人或其家属知情并同意参加试验； (3)入住ICU依据2012柏林标准诊断ARDS 72 h以内，且氧合指数介于150-300mmHg, 并伴有全身炎症反应综合征(SIRS)患者 (ARDS柏林标准和SIRS诊断标准见附录)； 排除标准： (1)慢性呼吸疾病的病史； (2)单纯的心源性肺水肿； (3)APACH2评分≥21分； (4)合并终末期疾病，或者临床主管医生判断近期患者预后不良； (5)ARDS病程>3天； (6)粒细胞缺乏或者接收免疫抑制剂或大剂量激素(甲强龙>40 mg)患者； (7)怀孕或哺乳； (8)曾经参与过本项研究； (9)不同意参加本试验； 主要观察指标： 1) 72 h氧合改善率[(D3氧合指数-D0氧合指数)/D0氧合指数]； 2) 28天无机械通气时间； 次要观察指标: 1) 28天有创机械通气率； 2) 28天住ICU时间； 3) 28天住院时间； 4) 28天全因病死率； 5) ICU病死率； 6)28天获得性感染发生率(定义为：实验室核酸或培养确诊的继发感染)； 7)血浆中NE及炎症因子IL-6、IL-10、CRP水平变化； 8)28天严重不良事件频率； 9) D1和D5氧合改善率；

摘要信息：目的 观察中性粒细胞弹性蛋白酶(NE)抑制剂对高血压性脑出血(HICH)患者实施穿刺引流术后氧化应激和炎性介质的影响及对神经功能的保护作用。方法 选择2016年1月至2017年6月收治的146 例 HICH 患者为研究对象,根据随机数字分为观察组(75 例)和对照组(71例)。对照组患者行软通道穿刺引流术后予常规临床治疗;观察组患者通过微量泵静脉注射NE抑制剂西维来司钠注射液0.20 mg/(kg·h),连续用药7 d。术前与术后3 d、7 d,检测两组患者的氧化应激指标与血清炎性因子指标;术后7d评估神经功能缺损评分。结果:术后3d、7d,观察组的血清丙二醛水平显著低于对照组,超氧化物歧化酶和谷胱甘肽过氧化物酶水平均显著高于对照组。术后3d7d,观察组多形核白细胞比例、肿瘤坏死因子、白介素(Ⅱ)-6、8、超敏C反应蛋白均显著低于对照组(均 P<0.05)。术后7 d,观察组的 NIHSS 评分低于对照组(8.3 +2.2 us 9.2±1.9),差异有统计学意义(P<0.05):总有效率高于对照组(88.0%u 78.9%)，但差异无统计学意义(P>0.05)。结论 HICH术后加用 NE 抑制剂能明显抑制机体氧化应激反应和炎性反应,有助于患者术后神经功能的改善。

摘要信息：[摘要] 目的 探讨中性粒细胞弹性蛋白酶(NE)与皮层下动脉硬化性脑病(SAE)的相关性。方法 选择 SAE 患者 60 例,按 GOTO 分型分为I型、Ⅱ 型及 Ш型即 A、B、C组,各 20 例,另选健康体检者 20 例设为对照组,检测各组血浆 NE含量。结果，对照织与病例组 NE含量差异均有统计学意义(均 P< 0.05):不同严重程度组间 NE含量差异有统计学意义(P< 0.05):I型与Ⅲ型组 NE含量差异有统计学意义(P< 0.05)。结论SAE 患者血浆 NE水平随着病情严重程度加重而升高。

摘要信息：【摘要】目的 探讨重度脑卒中患者急性期血浆中性粒细胞弹性蛋白酶(NE)的含量、变化及其临床意义。方法收集重度急性脑卒中患者 20 例(实验组),分别监测发病后 12h、24h、48h、72h及7d的血浆中NE含量,健康对照组 20 例。结果 实验组在7d观察中死亡2例,健康对照组 NE 含量(17.7±8.0)ng/ml。重度脑卒中患者发病72h时血浆中 NE含量与健康对照组、12h及7d时间点差异有统计学意义(均P< 0.05),其血浆中 NE 含量在发病 24h开始升高,72h时达到高峰,7d后复査恢复正常。结论、重度脑卒中患者血浆中 NE 含量升高,呈动态变化。在发病后 72h达高峰,此时更易发生炎症级联反应甚至导致 SIRS,为进一步研究相关问题提供了一定的理论依据。

摘要信息：【摘要】 目的 系统评价创伤性脊髓损伤(spinal cord injury,SCI)在中国的流行病学特征和疾病经济负担。方法 计算机检索 PubMed、EMbase、WanFang Data、VIP 和 CNKI数据库,搜集有关中国 SCI流行病学和疾病经济负担的研究,检索时限均从1978年1月1日至2017年8月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用 Stata12.0软件进行合并分析。结果 共纳人 32篇文献。Meta 分析结果显示:我国 SCI年患病率为 37人次/100万[95%CI(21,53)],平均年龄范围 34.7~54.4岁,男性高于女性。汽车碰撞和高空坠落是 SCI的主要原因。SCI严重程度从 A~E级(ASIA 分级)不等,以A级为主,E级比例最低。结论，当前证据显示，我国 SCI发病率较高,具有较高的社会和医疗负担,SCI主要由汽车碰撞和高空坠落弓起。受纳入研究数量和质量的限制，上述结论尚待更多高质量研究予以验证。

摘要信息：Background:This study reports a 10-year retrospective analysis of multiple trauma complicated by pulmonary contusion. The purpose of this study is to ascertain the risk factors for mortality due to trauma in patients with pulmonary contusion, the impact of various treatment options for prognosis, and the risk factors for concurrent Acute Respiratory Distress Syndrome (ARDS). Methods:We retrospectively analyzed 252 trauma patients with lung contusion admitted to the General Hospital of Guangzhou Command from January 2000 to June 2011 by using the statistical processing system SPSS 17.0 for Windows. Results:We included 252 patients in our study, including 214 males and 38 females. The average age was 37.1 ± 14.9 years. There were 110 cases admitted to the ICU, of which 26 cases with ARDS. Nine of the 252 patients died. We compared those who survived with those who died by gender and age, the difference was not statistically significant (P = 0.199, P = 0.200). Separate univariate analysis of those who died and those who survived found that shock on admission (P = 0.000), coagulation disorders (P = 0.000), gastrointestinal bleeding (P = 0.02), the need for emergency surgery on admission (P = 0.000), pre-hospital intubation (P = 0.000), blood transfusion within 24 hours (P = 0.006), the use of mechanical ventilation (P = 0.000), and concurrent ARDS (P = 0.000) are poor prognosis risk factors. Further logistic analysis, including the admission GCS score (OR = 0.708, 95% CI 0.516-0.971, P = 0.032), ISS score (OR 1.135, 95% CI 1.006-1.280, P = 0.039), and concurrent ARDS (OR = 15.814, 95% CI 1.819-137.480, P = 0.012), identified the GCS score, ISS score and concurrent ARDS as independent risk factors of poor prognosis. Shock (OR = 9.121, 95% CI 0.857-97.060, P = 0.067) was also related to poor prognosis. Patients with injury factors such as road accident, falling injury, blunt injury and crush injury, et al.(P = 0.039), infection (P = 0.005), shock (P = 0.004), coagulation disorders (P = 0.006), emergency surgery (P = 0.01), pre-hospital intubation (P = 0.000), chest tube insertion (P = 0.004), blood transfusion (P = 0.000), usage of hormones (P = 0.002), phlegm (P = 0.000), ventilation (P = 0.000) were at a significantly increased risk for ARDS complications. Conclusions:Those patients with multiple trauma and pulmonary contusion admitted to the hospital with shock, coagulopathy, a need for emergency surgery, pre-hospital intubation, and a need for mechanical ventilation could have a significantly increased risk of mortality and ARDS incidence. A risk for poor prognosis was associated with gastrointestinal bleeding. A high ISS score, high APACHE2, and low GCS score were independent risk factors for poor prognosis. If patients developed an infection or were given drainage, hormones, and phlegm treatment, they were at higher risk of ARDS. Pre-hospital intubation and drainage were independent risk factors for ARDS. In patients with ARDS, the ICU stay, total length of stay, and hospital costs might increase significantly. A GCS score < 5.5, APACHE 2 score > 16.5, and ISS score > 20.5 could be considered indicators of poor prognosis for patients with multiple trauma and lung contusion.