皮质类固醇治疗急性呼吸紧张综合征
Riccardo Guglielmi1, Antonio Campanella1, Jesús Villar2,3,4,5
1Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy.
Seminars in respiratory and critical care medicine
|November 11, 2025
概括
在急性呼吸窘迫综合征 (ARDS) 中早期使用葡萄糖皮质类固醇 (GC) 可以改善结果,但时间和患者表型至关重要. 根据ARDS阶段和炎症量身定制GC疗法可以优化治疗以获得更好的生存率.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 药理学 药理学是指药理学的学科.
背景情况:
- 急性呼吸窘迫综合征 (ARDS) 是一种复杂,异质的疾病,具有显著的死亡率.
- 了解ARDS的发病过程涉及不同的排泄,增殖和纤维增殖阶段.
- 葡萄糖皮质类固醇 (GCs) 显示出在ARDS中调节免疫机械路径的潜力.
研究的目的:
- 审查目前关于GC在ARDS中使用的证据.
- 为GC管理提出一个阶段特定和表型导向的框架.
- 确定未来的研究重点,以优化ARDS中的GC治疗.
主要方法:
- 叙述性审查整合了流行病学,病理生物学,药理学和临床证据.
- 对ARDS中GC使用的当代临床随机试验和元分析的分析.
- 讨论潜在类分析,识别不同的ARDS表型.
主要成果:
- 早期 (≤72小时) 的全身GC给药加快了胀的解决,缩短了通风时间,并改善了生存率.
- 一旦纤维扩散建立起来,就需要长时间的GC逐渐缩小.
- 延迟GC启动,病毒性肺炎或真菌共感染是GC使用的禁忌.
- 两种ARDS表型 (超高和低炎症) 可能对GC有不同的反应.
结论:
- 在ARDS中使用GC治疗需要仔细考虑疾病阶段,时间和患者表型.
- 生物标志物引导的精密疗法可能会取代目前的一种适合所有人的方法.
- 未来的研究应该专注于协调分子内型化与GC剂量,时间和逐渐缩小策略.
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