Ichikado Kazuya
Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto 861-4193.
Masui. 2013 May;62(5):522-31.
The clinical criteria of acute respiratory distress syndrome (ARDS) defined by the American-European Consensus Conference (AECC) in 1994 was relevant to clinical practice, trials, and researches for two decades. However, a number of issues with the AECC definition have become apparent. The updated and revised criteria of "The Berlin definition", addressing the limitations of the previous AECC definition, were published in 2012. In the first section of this manuscript, the Berlin definition based on data using patients-level meta-analysis of 4188 patients with ARDS, was reviewed. In the second section, the clinical significance and limitation of radiographic imaging, especially, high-resolution CT (HRCT) findings in ARDS were addressed. Although the early exudative phase of ARDS can not be detected even by HRCT, pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts increased mortality with an increased susceptibility to multiple organ failure, along with ventilator dependency and its associated outcomes.
1994年美国-欧洲共识会议（AECC）定义的急性呼吸窘迫综合征（ARDS）临床标准在二十年里一直与临床实践、试验及研究相关。然而，AECC定义的一些问题已变得明显。针对先前AECC定义的局限性，更新并修订后的“柏林定义”标准于2012年发布。在本手稿的第一部分，基于对4188例ARDS患者进行患者水平荟萃分析的数据，对柏林定义进行了综述。在第二部分，阐述了影像学检查尤其是高分辨率CT（HRCT）在ARDS中的临床意义及局限性。尽管即使是HRCT也无法检测到ARDS的早期渗出期，但早期ARDS患者通过HRCT评估的肺纤维增殖预示着死亡率增加，对多器官功能衰竭的易感性增加，以及呼吸机依赖及其相关后果。
