俞正秋　　马春芳　　蔡宛如

[摘要] 急性肺损伤/急性呼吸窘迫综合征是临床常见的危重病症之一，起病急、发展快、病死率高，尽管在过去几年中，重症医学的发展使得ARDS的院内发生率和死亡率大幅下降，但目前临床上仍缺乏特效的治疗手段。肺保护通气、积极抗感染治疗和限制性液体管理是目前主要西医治疗策略，近年来有部分改进从而进一步降低该病的死亡率。此外，关于ARDS异质性的研究是近年来热点，期望找到可靠的生物标志物和适当的治疗靶点，更好地开展精准化治疗。随着医药治疗ARDS的实验和临床研究不断深入，中医药治疗ARDS也取得了一定的成果。本文回顾了近年来国内外相关文献，总结了中西医关于此病的最新研究治疗进展，以期为ALI/ARDS的临床个体化治疗和药物研发提供新思路。

[关键词] 急性肺损伤;急性呼吸窘迫综合征;间充质干细胞;中医药

[中图分类号] R563.8          [文献标识码] A          [文章编号] 1673-9701（2021）13-0189-04

Advances in the treatment of acute lung injury/acute respiratory distress syndrome

YU Zhengqiu   MA Chunfang   CAI Wanru

The Second Clinical Medical College， Zhejiang Chinese Medicine University， Hangzhou   310053， China

[Abstract] Acute lung injury/acute respiratory distress syndrome is one of the common clinical critical illnesses. It has a rapid onset，rapid development，and high mortality rate. Although in the past few years， the development of intensive care medicine has led to a significant drop in the incidence and mortality of ARDS in the hospital. There is still a lack of clinically effective treatments. Lung-protective ventilation，active anti-infective treatment，and restrictive fluid management are currently the main Western medical treatment strategies. In recent years， some improvements have been made to reduce the mortality of this disease further. In addition， research on the heterogeneity of ARDS has been a hot spot in recent years， and it is hoped that reliable biomarkers and appropriate therapeutic targets can be found to better carry out the precision treatment. With the continuous deepening of experimental and clinical research on the medical treatment of ARDS， Chinese medicine treatment of ARDS has also achieved certain results. This article reviews the relevant domestic and foreign literature in recent years， summarizes the latest research and treatment progress of Chinese and Western medicine on this disease， in order to provide new ideas for individualized clinical treatment and drug development of ALI/ARDS.

[Key words] Acute lung injury; Acute respiratory distress syndrome; Mesenchymal stem cells; Traditional Chinese medicine

急性肺損伤（Acute lung injury，ALI）/急性呼吸窘迫综合征（Acute respiratory distress syndrome，ARDS）是重症患者呼吸衰竭的常见病因，临床上常表现为呼吸窘迫和进行性低氧血症[1]。ALI的最终严重阶段定义为ARDS。诱发 ALI/ARDS 发生的危险因素众多，常见的直接因素有严重肺部感染、胃内容物吸入、肺挫伤等，间接因素有肺外严重感染、严重的非胸部创伤、重症急性胰腺炎、大量输血等。

ALI/ARDS 属于临床常见的危重症，发病急骤、病死率高，是临床重症患者死亡的主要原因之一。据统计，美国每年新发ALI/ARDS成人患者的死亡率可达30%，其中老年患者人群的死亡率更高达60%[2]。……