Division of Pulmonary and Critical Care Medicine, Department of Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
Crit Care Clin. 2011 Jul;27(3):589-607. doi: 10.1016/j.ccc.2011.05.007.
Experimental and clinical evidence show a strong association between dysregulated systemic inflammation and progression of acute respiratory distress syndrome (ARDS). This article reviews eight controlled studies evaluating corticosteroid treatment initiated before day 14 of ARDS. Available data provide a consistent strong level of evidence for improving outcomes. Treatment was also associated with a markedly reduced risk of death. This low-cost highly effective therapy is well-known, and has a low-risk profile when secondary prevention measures are implemented. The authors recommend prolonged methylprednisolone at 1 mg/kg/d initially in early ARDS, increasing to 2 mg/kg/d after 7 to 9 days of no improvement.
实验和临床证据表明，系统性炎症失调与急性呼吸窘迫综合征（ARDS）的进展之间存在很强的关联。本文综述了八项评估在 ARDS 第 14 天之前开始的皮质类固醇治疗的对照研究。现有数据提供了一致的高水平证据，表明可改善结局。治疗还显著降低了死亡风险。这种低成本、高效的疗法广为人知，并且在实施二级预防措施时风险较低。作者建议在早期 ARDS 中最初以 1mg/kg/d 的剂量使用甲泼尼龙，在 7-9 天无改善后增加至 2mg/kg/d。
