摘要
隨著重症醫學照護的進步，急性肺損傷病人的死亡率，從早期的50%-70%，在1990年代末期逐漸下降到40%。近十年來治療的最大進展，是使用低潮器容積的呼吸器設定，使得病人的死亡率進一步下降到30%左右。目前並無顯著證據支持使用高吐氣末正壓、肺泡回復術或是俯臥姿勢，可有利於急性肺損傷病人的預後。放置肺動脈導管並無法降低急性肺損傷病人之死亡率，同時對於這類病人，給予輸液的策略以限制輸液療法爲宜。類固醇角色仍有爭議，尤其是急性呼吸窘迫症候群已發生兩星期以上的病人，給予類固醇可能會增加死亡風險。表面張力素與一氧化氮療法仍屬於實驗性質，它的臨床價值仍待以後更多的研究證實。
並列摘要
With the advances of critical care, the mortality rate of acute lung injury fell gradually from 50-70% in the early times to 40% by the late 1990s. In the recent ten years, the most important breakthrough is the development of lower tidal volume ventilation, which further lowers the mortality rate to around 30%. Current evidences do not support routine use of high positive end-expiratory pressure, lung recruitment maneuver, and prone positioning in patients with acute lung injury. Pulmonary artery catheter-guided therapy did not improve survival in those with acute lung injury and conservative strategy of fluid management is more appropriate to such patients. The role of corticosteroid is still controversial. Starting methylprednisolone therapy more than two weeks after the onset of acute lung injury may increase the risk of death. Surfactant and nitric oxide therapy also need more studies to prove their values in the clinical outcome of acute lung injury.
延伸閱讀
- 楊志新（2014）。肺癌治療新進展。台灣醫學，18(6)，641-643。https://www.airitilibrary.com/Article/Detail?DocID=10281916-201411-201412110011-201412110011-641-643
- 許志新（2016）。肺動脈高壓治療藥物之新進展。台灣醫學，20(2)，158-166。https://doi.org/10.6320/FJM.2016.20(2).5
- 呂家嘉、傅彬貴（2021）。特發性肺纖維化急性惡化－診斷、危險因子與機械通氣處置策略探討。內科學誌，32(1)，8-19。https://doi.org/10.6314/JIMT.202102_32(1).02
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