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《Medical Journal of Chinese People's Liberation Army》 2009-04
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Recent progress in research on the diagnosis and treatment of acute lung injury and acute respiratory distress syndrome

QIAN Gui-sheng. Institute of Respiatory Disease of PLA,Xinqiao Hospital,Third Military Medical University,Chongqing 400037,China  
Acute lung injury(ALI) and acute respiratory distress syndrome(ARDS) are commonly encountered serious diseases.The pathogenesis of ALI and ARDS remains unclear at present.The mortality rate of ALI and ARDS remains high due to the Absence of sensitive method for early diagnosis and specific and effective therapy.The present paper will focus on the latest developments of diagnosis and treatment for ALI and ARDS.Diagnosis:Althongh theoretically it is possible to look for the diagnostic markers and target of injury by painstaking study of its pathogenesis,but as yet an ideal pathognomonic marker with due sensitivity and specificity remains unavailable.Diffuse alveolar injury is a major pathological feature and may act as a reliable parameter for the diagnosis of ALI and ARDS.However,it is difficult to obtain the lung tissues from living patients with ALI/ARDS,and dynamic monitoring of arterial blood gas,combined with clinical symptoms,is still the main criterion for early diagnosis of API and ARDS in clinical setting.Therapy:The use of corticosteroids to subdue rampant inflammatory reaction had not given a promising result in clinical study,so it is not recommended for routine use,however short-term corticosteroids may be considered for allergy-or aspiration-induced ALI in early stage.With the treatment of primary diseases as the main strategy,the main therapeutic measures for ALI/ARDS should be integrated treatment of multiple targets and correction of hypoxia.Mechanical ventilation is the main substitutive therapy for correction of hypoxia.Protective ventilation with adequate tidal volume and positive end-expiratory pressure(PEEP) are recommended.Briefly,management of primary disease,correct use of mechanical ventilation,nutritional support and specific treatment for pathological changes and clinical manifestation are important for ALI and ARDS patients.Hereafter,emphasis should be placed on seeking the methods for early diagnosis and effective therapies for diffuse alveolar injury and massive inflammation.
【Fund】: 国家自然科学基金资助项目(30770928);; 军队“十一五”攻关课题(06G083);; 重庆市自然科学基金资助项目(2007BB5072);; 第三军医大学科研基金资助项目(2006HG04)
【CateGory Index】: R563.8
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