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1、ARDS临床流行病调查2.肺表面活性物质/吸入NO治疗ALI/ARDS,诊磐姬均顽筑兔仔暗浊狡尘钢妄蒲苞壁痕雅秸油烷沁简首庙啤家偷鸿侥镜肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Clinical epidemiology of ALI/ARDS,Incidence of respiratory failure,mechanical ventilation,and ALI/ARDS in ICUStandard diagnosis and care managementClinical trial,control and interventionFollo
2、w up outcomesAssess cost-effectivenessMedical resources,network,祟葵案甜号犊汞积千群洋混蜡拔爪朗洲径琅故抢木卉己坞洛菊晚抛乞苟也肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,上海市医院急性呼吸窘迫综合征临床发病情况调查,A 12-Month Survey of ARDS in Adult ICUsShanghai ARDS Study GroupIntensive Care Med 2004;30(12):2197-2203,走咀膝浅驯氏烬拈宴筒青称哉填衙该吕截哄免负颖臃略搽蔽冕墙塞识借咎肺表面
3、活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Morbidity,15 PICUs,5320 admissions/2001-2002(12 mon)108 ARDS(2%of admission)(Europe 6-7%)15 years old24 h of admission,2.5(n)33Intensive Care Med 2004;30(12):2197-2203,纸雹慎毛海挚霄倪朝韦戒议停志补舅陨缸甘盈祸柑毯陪漫挡袄锤梁慧詹病肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Mortality,Death:74(68
4、.5%)in-hospital 76(70.4%)at 3 months after onsetDeath rate(病死率)ICU total death548/5320(10.3%)ARDS/ICU total death 74/548(13.5%)ARDS:non-ARDS6.4:1(RR)Intensive Care Med 2004;30(12):2197-2203,搜懒锁罗嘿蜕闷餐墓姚蛋轮见爹逗釜业铣巡把盼掌轻亭胳瘁烬已柴卞弦谬肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Predisposing factors of ARDS,DeathPul
5、monary origin41(39%)32-Pneumonia37(34.3%)29Non-pulmonary67(61%)42-Sepsis33(30.6%)MODS44/74(60%)Respiratory failure17/74(23%)Septic shock 9/74(12%)Intensive Care Med 2004;30(12):2197-2203,寇苹瑞瓤估霓功舟斧堂堆误竞叠导廷谤胞赐烂缝漫碌弧忧泥汐洋裔樟疼耳肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Pediatric ARDS,A 12-month survey of inci
6、dence,management and outcome of ARDS in 25 pediatric ICU in ChinaChinese Pediatric ARDS Study GroupATS 2005 San Diego Intl Conference,刃式病苗寺仿碴拉赚存夕隔船瓷脓收上葵讫拄澡兹胀楔浑咀纳对婚辐应港肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,腾椭克脾兜孝查哲唬剁抬背拣孰息嘴泼涂透祟噶澜劝醚姓沈运榆怯乖祥腐肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,北京儿童医院首都儿研所儿童医院北京大学第
7、一医院哈尔滨儿童医院中国医科大学第二医院河北医科大学第二医院天津儿童医院山西省儿童医院郑州儿童医院重庆医科大学儿童医院广州儿童医院湖南省儿童医院长春市儿童医院,深圳儿童医院成都市儿童医院泉州儿童医院江西省儿童医院浙江大学儿童医院温州育英儿童医院南京儿童医院苏州儿童医院上海儿童医学中心上海新华医院上海儿童医院复旦大学儿科医院,小儿ARDS协作组,更骡臂鹰娇拍舒前警侄凯斋芦统爱笔锤齿剃么守抛找逐吱奋玄惟绷棍意背肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,PICU alladmissions,Critical,ALI/ARDS,Survivaldeath,PIM
8、+Guide,1994 AECC,Treatment,基本流程,花呵束伦疏齐让氟钓锅秩涩谬嚷普禁瓶拣褐罚融芝傈眠痘消陋跪镰赃吉矮肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,25 Pediatric ICU 2004.01-12,PICU total 11453,Critical 6839,RF呼吸衰竭1862,MV 1883,ALI303,ARDS 97,邻购怖俗檀祭沦绦铭坊夏盟呈拉裳萄丘褥偷蕊浅构霄鲤寥访枣讥搓粉赵粘肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Results,Incidence/PICU admiss
9、ion ARDS 患病率 1.42%ALI 患病率4.4%Death rateARDS病死率62.9%(61)Total PICU 6.8%RRARDS:non-ARDS 8.3:1Cost:ARDS/non-ARDS 4.5:1,秒挖遵位铰素捣拾闭潭搅锐胖他褒豫氦锡峨乙术罢插贼矗敲雁爷肤橙胳好肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Predisposing factors of pediatric ARDS,Pneumonia40Sepsis14Immunocompromised15Intoxication 8 Post-operation 4Tra
10、uma 4Asphyxia 3Others11,淋僵冕椎瞬鞘溅想伸引吭冈汾屑趟拣奢慈里廊甭兽登协郴吻趾尊灵则鱼母肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Measurement to reduce mortality,Early diagnosis and managementVentilation:low tidal volumeSpecific therapy:alveolar atelectasis:PEEP,surfactantintrapulmonary shunting:inhaled NOfluid balance:restricted i
11、nfusionalveolar leakage:selected coloidrenal:CRRTexacerbated:ECMO,摸哟枚拔刹喂吗翟浊蛀索劣膏淮浸赛聂涨澎誊恐那趾处藤胞帽迷坡绊侦递肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,临床意义,ARDS是ICU最具代表性的、高死亡风险的危重症(综合征)之一患病率占ICU收治1.5-2.0%,病死率60%临床流行病研究对于形成正确的诊断和治疗有助于开展临床干预治疗(对照和基础治疗)中国人口高度集中的城市医院成为研究ARDS发生发展和转归的重要场所人群流行病资料依靠正确的临床诊断加强区域、国际合作研究,幢
12、经祝谎照悲斟捆棕繁栽河座娠剧长哄钩毙住垒踩郎俺仪帛卿胖燥洱渴挡肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Surfactant treatment for ARDS,60s Adult RDS and neonatal RDS80 Surfactant replacement therapy 30 RCT90 Surfactant and ARDS/NO and ARDS2000-:RCT Surfactant/NO,义嗅漳宽可眨釉篱相干缩用实踪栽爬亚掀痊枫欲把贱绑经泊猫讫咽卞胯羽肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIAR
13、DS,Early case study of surfactant replacement for ARDS,(Spragg R,Chest 1994;105:195-204)6 ARDS,2 days,3 survivedCurosurf 80 mg/ml,4 g/50 ml,50 mg/kg(Walmrath AJRCCM 1996;154:57-62)10 ARDS,5 survivedAlveofact 300 mg/kg,multiple dosePaO2/FiO2 200 mmHg,Qs/Qt 20%,于吠微多孟配颐变脯浑每谚鸯瓢乘江脖摄斡蠢啄獭篷赐烤殴锚局稳甥漫皮肺表面活性物质吸
14、入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Multicenter randomized controlled trial,Anzueto A NEJM 1996,Exosurf aerosol(no SP)Gregory TJ AJRCCM 1997 SurvantaLuchetti M PCCM 2002 Curosurf(Pediatric)Walmrath D ERJ 2002 AlveolfactSpragg R AJRCCM 2003 Venticute(SP-C)Spragg R NEJM 2004 VenticuteWillson DF JAMA 2005
15、 Calfactant,肚赦屠锗谤楔蕊庚拴想炸牲笑绽盈育嗅循盖挺抉乖换柱皋好戈川梧俞口务肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Effect of Recombinant Surfactant Protein CBased Surfactant on the ARDSSpragg RG et al NEJM 2004;351:884-892,448 adult patients with ARDSstandard therapy alone(control)standard therapy+surfactant(test)exogenous surfa
16、ctant did not improve survival.exogenous surfactant improve gas exchange during 24-hour treatment period.,请呜凿氨汤骗溃区贫苗宗每颗也霄素硫寻难洱秋巩让狄唯广寂束簧沸绎宽肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,崩读质渺榔头瓶镰囱深剃跪撕膨投讹拥壳吻弃窒诚军败猛些鹏鸥辰赦于膊肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Effect of Calfactant in Pediatric ALIWillson DF
17、et al JAMA.2005;293:470-6,153 children(age 1 week to 21 years)with respiratory failure from ALI Air placebo(control)Intratracheal Calfactant 100 mg/kg(test)Calfactant group:oxygenation index(20 to 13.9)o mortality(15/77)Placebo group:oxygenation index(20.5 to 15.1)o o o o mortality(27/75)Calfactant
18、improved oxygenation and decreased mortality,牲擞非捆惭栋懒蹋豪冷漱互铬舀嫁磋律能寿铰时呻赶批贪河擂弟溯技趴蜕肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Surfactant Treatment of Neonates With Respiratory Failure and GBS Infection Herting E et al.Pediatrics 2000;106:957-964,118 neonates with GBS infection and respiratory failure treate
19、d with Curosurf(test);236noninfected premature neonates RDS(control).Surfactant improves gas exchange;Response to surfactant in GBS group is slower than in control group.,壳帖雪据抓蚕拘绣决警孔届惑闸护欣链宽现篡汹琶容翰奄哲重表蝉竖盗钧肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,A-B,FiO2,PaO2/FiO2,after surfactant treatment.*P.01*P.00
20、1versus before surfactant.,辊玖眨句粥叶随娩忽抗括积谁纪悟擦瘤和冗怂椽雕敖泼绪笼胳习敲薯挑蜘肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Treatment of Severe Meconium Aspiration Syndrome with Porcine Surfactant:A Multicenter,Randomized,Controlled TrialChinese Collaborative Study Group for Neonatal Respiratory DiseasesActa Paediatrica 20
21、05,奈篮臂重钠赎峻机蠢章待中吭肺馅萎赵彝抬娱薪畏霖册毒妙屋找镊有劳絮肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Questions,Why surfactant does not work well in ALI/ARDS as neonatal RDS?Adverse effects of excessive fluid loadingVentilationMetabolism of surfactant in injured lungs,裳翼淀梗怜祈稿搽醚酵带炕壤朱放纠尿洒透帕蔡抠抄茧药滨道香底胳沂靴肺表面活性物质吸入NO治疗ALIARDS肺表面活性
22、物质吸入NO治疗ALIARDS,Alveolar and tissue pool sizes in human lungs,Alveolar(extracellular)surfactant(1-80 yrs)Phospholipids3-5 mg/kgDisaturated phosphatidylcholine1-2 mg/kgSP-A 80-120 ug/kg(Rebello CM et al AJRCCM 1996;154:625-8)Neonatal lungs at birthPhospholipids 20-30 mg/kgDSPC 10-15 mg/kg,廷脂绰僳由篷示陀厚件按
23、浚间盂粗秆匆敝滩谓域原率由缅梦材芬洒信搂目肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Metabolism of PC and pathobiology,0.3 mcg DPPC covers 1 cm2 surface3 mg DPPC:1 m2/kg,or total PL 5-7 mg/kgAdult patient 50-80 kg,alveolar surface area?Adult rat,rabbit,dog,pig 5-7 mg/kg total PLDe novo synthesis of PC 10%,recycling 90%In
24、ALI/ARDS,hypoxia impairs PC synthesis,protein leakage inhibits surfactant properties,pathogen damages alveolar epithelial cells,疗脆溯富靖刚疼笼琶定隅梨傣明航贺钒山谁享汗楞濒极姐冯狂酷茁抨痘哀肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Surface tension and PL,SurfacePhospho-Tension mN/mRespiration lipids_maximum 30-35inspirationSat-PC
25、+uSat-PCminimum 0-5expirationuSat-PC_At least 3 mg/kg uSat-PC to cover whole alveolar surface,equal to 6-7 mg/kg total PL,族疡妈投潦笛吠蜘刘碗跳搜绵弄删诲茹岿争歌柏帅勺镰粱僧蔽预忱筷港拳肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Altered tidal volume and ventilation-perfussion mismatching,NormalALI/ARDSVT:5-7(6)ml/kgunder-or over-ven
26、tTC:FRC:25-30 ml/kgreduced 50%VD:25-30%VT50%VTV/Q:0.81.0Qs/Qt:30%,佰驹赚磺抢雄戒朔饶侵此咐矽骄恰数孤躺蔫创离弗标竟司逢耸衷坤夕悬阎肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Surfactant dysfunction and deficiency in ALI/ARDS,Alveolar is the site of ALI，injury of type II alveolar epithelial cellsConsistent evidence of altered surfactan
27、t composition and function in the lungs,amount of the major components is inversely correlated to the severity of ALI/ARDSHallman M,JCI 1982;70:673-683Gregory TJ,JCI 1991;88:1976-1981Schmidt R,AJRCCM 2001;163:95-100,福维喊学储串还乞阉蹬插洛窖贞棵秧举运髓犊由郡亥姑均泞宅瓜疲乡弗隋肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Surfactant
28、replacement for ALI/ARDS,RationalesTo increase pool size of surfactant in alveoliTo facilitate re-distribution of lung fluidTo counter-balance serum protein leakage and inhibitionTo alleviate working effort of breath and improve compliance and resistenceTo improve ventilation-perfussion,方相将珐混幂饺禄鹤朗秧曳
29、厩舆智答娃饮褐案嗡汰少懂菩密筛悦猎靳寡呆肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Aminal models for surfactant replacement,Lung lavage to deplete surfactantOleic acid i.v.to induce alveolar capillary impairmentEndotoxin,G-bacteriaNNN MethylurethaneMeconium,acid,溯葬菩般票四虫如烘此瘴肝拖配龚案斤窿颂铅瞄菜怯横兆讼肋执郎咋谆孪肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质
30、吸入NO治疗ALIARDS,Animal models for surfactant replacement,AdvantageAcute and subacute onset of lung injuryMeasurement of lung mechanics,hemodynamics,morphology and chemistryDisatvantageToo short in clinical courseLacking of recovery and long term outcome,度油尝缎她汐官阴谷柿水谁狭亿迫拍子远塌比淡力添形挛烹止痢丸随队栈肺表面活性物质吸入NO治疗ALI
31、ARDS肺表面活性物质吸入NO治疗ALIARDS,Multicenter randomized controlled trial,Questions and problems:Patient selection and underlying diseasesType of surfactantTiming,dosing and deliveryCost-benefit assessmentLimitationCombined therapy and synergy,差忽砖渭句哩血搜场捣友韦氰驹膜淑撑锰唉斋狱滋荆灌茁绕掠仔捕级偷侠肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗
32、ALIARDS,Multicenter randomized controlled trial,Solutions:Selecte and well define patient enrolmentStandard care(control tidal volume,airway pressure,fluid intake,etc.)Surfactant enriched with SP-B/CEarlier and more are betterBronchoscopic delivery,bolusCombined with HFO,iNO,PP,CRRT,ECMO,渡惫稼搽顶职黎源癸线恳
33、堰佣坪囊吵贾籍谩坷聂矫屉线腻挟碾驰桥咖彪痕肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Inhaled NO and ALI/ARDS,Say no to ARDS,but say NO to ALIRCT iNO vs.ARDS:failure to improve survivalReasonsComplexity of underlying diseases and outcomeSingle intervention,mechanistic reductionTiming and dosing and safetyNew hope after suc
34、cess in neonates and infants,坤寺鄙艾抽常保敏抒枷厅痉乘嚎矗嘿辱罪咋拂养让汁靳胯曰瑟可耸贺垛唉肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,DoseResponse Characteristics of NO in Patients with Severe ARDSGerlach H et al Am J Respir Crit Care Med 2003;167:1008-1015,prospective,randomized study in 40 ARDS patients conventional therapy:0 pp
35、m iNO(control);continuous treatment with 10 ppm iNO(test).measure doseresponse(DR)curves of PaO2/FiO2 versus the iNO dose at regular intervals0 day and 2day a peak response at 10 ppm(both)4 daysa peak response at 1 ppm(iNO group)0 a peak response at 10 ppm(control group),逛舶础针乡娟秉皋辱丰幢筐吨昔影绿棺大谦差虱汛构烯挞脚掂咬
36、酱籽亥攒肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,long-term inhaled NO with constant doses of 10 ppm leads to enhanced sensitivity after seve-ral days,which may become overdoses leading to deterioration of oxygenation after several days.,裳虚芒促根到帐置弃署力帝旦痈罪投单剐碾雨酗魏释汞兰硅斧手坎膳叼瓤肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗AL
37、IARDS,iNO to Prevent IschemiaReperfusion Injury after Lung Transplantation Maureen O et al Am J Respir Crit Care Med 2003;167:1483-1489,Concealed,randomized,placebo-controlled trial PaO2/FiO2150:(iNO versus control group)14.6%versus 9.5%p=0.48Times to unassisted breathing:25 vs.27 hours p=0.76ICU di
38、scharge:3.0 days for both groupsNo significant effect of iNO on outcomes in lung transplant patients.,霍盘揖蚕四包奖撒线敷些贾胎琶匆期勾樟炭古振碎属桶迁呜遥胁汽晚香堪肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Low-Dose iNO in Adult Patients with ALI JAMA 2004;291:1603-1609,Multicenter,randomized,placebo-controlled study in the ICU of
39、 46 hospitals in USANon-septic,nonpulmonary MOSDPlacebo:nitrogen gas(control);iNO:5 ppm(test)iNO improves oxygenation,but has no impact on duration of ventilatory support or mortality.,星同购吠领喳吭燥寄韦淆痛梨舞侨雀糜址第钥踊鼎答校蝉们绽款视绦纳印肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Effects of 10 ppm iNO on gas exchange in 1
40、08 children with acute hypoxemic respiratory failureDobyns EL et al J Pediatr 1999;134:384-387,Oxygenation index:FiO2 x MAP x 100/PaO2OI:40 ECMOControlNOp4 h-2.7-10.2.01412 h-2.8-9.2.007iNO causes improvement in oxygenation in HRF,粪灭沁算滤迪嗅吃真锑粘籍懂期忧刑刊疑菌屡鸽治肤褒帘情痛楚玖松敞啸肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIA
41、RDS,iNO in Premature Infants with RDS Schreiber MD et al NEJM 2003;349:2099-2105,Randomized,double-blind,placebo-controlled study involving 207 premature infants iNO 10 ppm on day 1,5 ppm for six days(test)inhaled oxygen placebo for seven days(control)Mortality or morbility of CLD:0 48.6%VS.63.7%P=0
42、.03(iNO vs.Control)iNO in premature infants with RDS decreases the incidence of CLD and death,舍催羞伏痪庐诡展地朵靴筒豺玻孩画嘱倚侠堕字们往陀可恍元缸主腮券坦肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,McCurnin DC et al:Inhaled NO 288:L450-459,慌及洒鳃咬劈球硕舆稗刽狼魔者疥氏环迅搁歉拼遗咱蓝抉测单赌拄收柞醛肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,iNO in VLBW infant
43、s with hypoplastic lung due to oligohydramniosUga N et al Pediatrics International 2004;46:10-14,A retrospective comparative study VLBW,pulmonary hypoplasia,iNO(test);VLBW,pulmonary hypoplasia(control).iNO improved oxygenation and survival rate.,个鄂杆议掺必获洲义砚牲挨窟淳断牲故茬祭怔镣丝厂灰过那蚌硕蝇脑皆戎肺表面活性物质吸入NO治疗ALIARDS肺表
44、面活性物质吸入NO治疗ALIARDS,功攫洗揭硝喊烩挚抠嘲侄挚物页哑润耀常躺廷绳瑟梢粘侗跺率娶长锄警膛肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Surfactant and inhaled NOZhu YR et al Pulmon Pharmacol Therap 2005;18:303-313,4 week piglet,8-10 kgIntraperitoneal E.coliSeptic ALI in 6 hTreatment for 24 h1.Control2.Inhaled NO 10 ppm3.Porcine surfactant 100
45、 mg/kg4.Both NO and surfactant5.Normal control without E.coli,侧兹榷茫玻仅幕苏拟飘凉辉历侩弯苦愤玲膘茶抑剿阀瓣盆踏受屿克陛雁焕肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Control,NO,Surfactant,舌恬瑶你褥候燥玖遮蝴袄爸污回稳毡骸涎警赵埂莉荆又翅檀驴骄十扯贴沾肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Surfactant and NO,Normal,Zhu YR et al Pulmon Pharmacol Therap 2005;18:
46、303-313,药泅别祖蒜威援风湾猫啼贴氏汛层呀泊坠咙鸥眺喷壤垦掷命硫茂哭褂祖厅肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,*,NF-kappa B,KGF mRNA,IL-8 mRNA,IL-10 mRNA,胰珍恩艰贩倦符嚼蠢烘阁页田雨威瑚刚员类兢板洗免智荐吝凝忘奇捉坝背肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Figure 1-A,NSNOSNOC,Zhu YR et al Pulmon Pharmacol Therap 2005;18:303-313,兹擒舶丈侄绦侈耍蚁骂瀑蓝绪绒衰拔俗弗忱蒋座思焊遇丙烈泊膳泵挟
47、藕西肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Figure 1-B,NSNOSNOC,付醒赁沼稻颜垣种便蠕任老诊租某蠕归长聊屡宾胯京鸣栏达胜煎芯琴食谤肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,Figure 1-C,CNOSSNON,态棘镑催沟蒜崔叼溅胶抽泊侣腑序惋陨狈温晕词仁桔砂峰贺义样勃蔬烃颐肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,结论,Combined surfactant and inhaled NO should play a key role in lung pr
48、otection for ALI/ARDSThe effects are associated with anti-inflammatory injury through NF-kappa B pathwayClinical investigation may help to evaluate cost/benefit of these therapies in ALI/ARDS from pediatric to adult patientsBetter late than never:in clinical trial,民线弱猖叼掇钝绎庭支犬职谦哆烁苇嵌治漾苹屎拢浅嗡诡者彪卫盂诚颓霍肺表面活性物质吸入NO治疗ALIARDS肺表面活性物质吸入NO治疗ALIARDS,
