Lee Hyun-Sung, Lee Jong Mog, Kim Moon Soo, Kim Hyae Young, Hwangbo Bin, Zo Jae Ill
Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
Ann Thorac Surg. 2005 Feb;79(2):405-10. doi: 10.1016/j.athoracsur.2004.07.079.
The acute respiratory distress syndrome (ARDS) that develops after thoracic surgery is usually lethal. The use of corticosteroids to treat ARDS has been the subject of great controversy.
Therefore we compared conventional therapy with early low-dose steroid therapy in the treatment of postoperative ARDS. Methylprednisolone was given daily as an intravenous push every 6 hours and was changed to a single oral dose or discontinued, with a loading dose of 2 mg/kg followed by 2 mg/kg per day.
Over 2.5 years, 523 major thoracic operations were performed with postoperative ARDS developing in 20 patients (3.8%), of which 8 were treated with conventional therapy and 12 with early low-dose steroid therapy. Early low-dose steroid therapy significantly reduced postoperative mortality, with 7 patients (58.3%) recovering without mechanical ventilation.
We believe this is the first clinical study of low-dose methylprednisolone at an early phase of postoperative ARDS. The beneficial effects of the use of early low-dose steroids in ARDS are consistent with the hypothesis that fibroproliferation is an early response to lung injury, which is inhibited by early low-dose steroid therapy without disturbing operative wound healing.
胸外科手术后发生的急性呼吸窘迫综合征（ARDS）通常是致命的。使用皮质类固醇治疗ARDS一直是备受争议的话题。
因此，我们比较了传统疗法与早期小剂量类固醇疗法在治疗术后ARDS中的效果。甲基泼尼松龙每6小时静脉推注一次，每日给药，之后改为单次口服剂量或停药，负荷剂量为2mg/kg，随后每天2mg/kg。
在2.5年的时间里，共进行了523例大型胸科手术，其中20例（3.8%）发生了术后ARDS，其中8例接受传统疗法治疗，12例接受早期小剂量类固醇疗法治疗。早期小剂量类固醇疗法显著降低了术后死亡率，7例患者（58.3%）在无需机械通气的情况下康复。
我们认为这是第一项关于术后ARDS早期使用小剂量甲基泼尼松龙的临床研究。早期小剂量类固醇在ARDS治疗中的有益效果与以下假设一致，即纤维增生是对肺损伤的早期反应，早期小剂量类固醇疗法可抑制这种反应，且不会干扰手术伤口愈合。
