Pediatric Critical Care Medicine, Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, University of Southern California , Los Angeles, CA , USA.
Developmental Biology and Regenerative Medicine Program, Department of Surgery, The Saban Research Institute, Children's Hospital Los Angeles, University of Southern California , Los Angeles, CA , USA.
Front Pediatr. 2016 Mar 30;4:28. doi: 10.3389/fped.2016.00028. eCollection 2016.
Clinical and basic experimental approaches to pediatric acute lung injury (ALI), including acute respiratory distress syndrome (ARDS), have historically focused on acute care and management of the patient. Additional efforts have focused on the etiology of pediatric ALI and ARDS, clinically defined as diffuse, bilateral diseases of the lung that compromise function leading to severe hypoxemia within 7 days of defined insult. Insults can include ancillary events related to prematurity, can follow trauma and/or transfusion, or can present as sequelae of pulmonary infections and cardiovascular disease and/or injury. Pediatric ALI/ARDS remains one of the leading causes of infant and childhood morbidity and mortality, particularly in the developing world. Though incidence is relatively low, ranging from 2.9 to 9.5 cases/100,000 patients/year, mortality remains high, approaching 35% in some studies. However, this is a significant decrease from the historical mortality rate of over 50%. Several decades of advances in acute management and treatment, as well as better understanding of approaches to ventilation, oxygenation, and surfactant regulation have contributed to improvements in patient recovery. As such, there is a burgeoning interest in the long-term impact of pediatric ALI/ARDS. Chronic pulmonary deficiencies in survivors appear to be caused by inappropriate injury repair, with fibrosis and predisposition to emphysema arising as irreversible secondary events that can severely compromise pulmonary development and function, as well as the overall health of the patient. In this chapter, the long-term effectiveness of current treatments will be examined, as will the potential efficacy of novel, acute, and long-term therapies that support repair and delay or even impede the onset of secondary events, including fibrosis.
儿科急性肺损伤（ALI），包括急性呼吸窘迫综合征（ARDS）的临床和基础实验方法，历史上一直侧重于对患者的急性护理和管理。此外，人们还致力于研究儿科 ALI 和 ARDS 的病因，临床上定义为弥漫性、双侧肺部疾病，导致功能受损，在定义的损伤后 7 天内出现严重低氧血症。损伤可包括与早产相关的辅助事件，可继发于创伤和/或输血，也可作为肺部感染和心血管疾病和/或损伤的后遗症。儿科 ALI/ARDS 仍然是婴儿和儿童发病率和死亡率的主要原因之一，特别是在发展中国家。尽管发病率相对较低，范围从 2.9 到 9.5 例/10 万患者/年，但死亡率仍然很高，在一些研究中接近 35%。然而，这与历史上超过 50%的死亡率相比有了显著下降。几十年的急性管理和治疗进展，以及对通气、氧合和表面活性剂调节方法的更好理解，都有助于改善患者的康复。因此，人们对儿科 ALI/ARDS 的长期影响产生了浓厚的兴趣。幸存者的慢性肺部缺陷似乎是由不当的损伤修复引起的，纤维化和肺气肿倾向作为不可逆转的继发性事件出现，这可能严重损害肺部发育和功能，以及患者的整体健康。在这一章中，将检查当前治疗方法的长期效果，以及支持修复和延迟甚至阻碍继发性事件（包括纤维化）发生的新型急性和长期治疗方法的潜在疗效。
