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    标 准 与 指 南 ·

    中国危重病急救医学 2 0 0 6年 1 2月第 1 8 卷第 1 2 —

    ~ C h i n Cr i t Ca r e Me d, De —

    ce m be r 2006, Vo1 .18, No.12

    急性肺损伤/ 急性呼吸窘迫综合征诊断和治疗指南 ( 2 0 0 6 )

    中华 医学会重症 医学分会

    Gu i d e l i n e s f o r ma n a g e me n t o f a c u t e l u n g i n j u r y / a c u t e r e s p i r a t o r y d i s t r e s s s y n d r o me：a n e v i d e n c e — b a s e d

    u p d a t e b y t h e Ch i n e s e S o c i e t y o f Cr i t i c a l Ca r e Me d i c i n e( 2 0 0 6)Ch i n e s e So c i e t y o f Cr i t i c a l C a r e Me di c i n e ，Ch i n e s e M e di c al As s o c i a t i o n

    Co r r e s p o n di n g a u t h o r s ：QI U Ha i — b o( ， ) e p a r t me n t o f Cr i t i c a l Ca r e Me di c i n e .Na n j i n g Z h o n gd a Ho s pi t a l ，So u t h — Ea s t Un i v e r s i t y，Na n j i n g 2 1 0 0 0 9 ，Ji a n gs u，Ch i n a . Ema i l ：h a i b o q 2 0 0 0 @ y a h o o .c o m.e n)a n d L， 【 ，Da — we i( De p a r t me n t o f Cr i t i c a l C a r e Me d i c i n e ，Pe k i n g Un i o n Me di c a l Co l l e g e Ho s p i t a l ，Ch i n e s e Me d i c a l

    Sc i e n c e Ac a d e my，Be i j i n g j 0 0 7 3 0 ， Ch i n a .Ema i l ：d wl i u @ me d ma i l . c o m. c n o r d wl i u @ p u mc h . c n )

    【Ab s t r a c t ] Ob j e c t i v e I n 2 0 0 6 ，Ch i n e s e c r i t i c a l c a r e e x p e r t s d r a f t e d ma n a g e me n t g u i d e l i n e s f o r

    d i a g n o s i s a n d t h e r a p y o f a c u t e l u n g i n j u r y ( ALI )/ a c u t e r e s p i r a t o r y d i s t r e s s s y n d r o me( ARDS) ，t h a t wo u l d

    b e of p r a c t i c a l u s e f or t he c l i n i ci a n，a n d t hi s e f f or t ma y s e r v e t o i nc r e as e na t i on wi d e a war e ne s s a nd t o i m p r ov e

    t h e t r e a t ment r e s ul t of ALI / ARDS.M et h o ds Th e p r o c e s s i nc l ud e d a modi f i e d De l ph i me t ho d，a c o ns e ns us

    c onf er e nc e， s ev e r al s ub s e qu e nt s ma l l e r me e t i n gs of s u bgr oup s an d k ey i nd i v i d ua l s· t e l e c onf e r e nc e s， a n d

    el e c t r o ni c ba s e d di s c u s s i on a m o ng s ubgr o ups and a mon g t he e nt i r e c ommi t t e e . The mo di f i ed De l phi

    me t ho do l o gy u s e d f or gr ad i ng r e c omme nd a t i o ns was de r i v e d f r om a 2 001 publ i c at i o n s po ns o r e d by t he

    I nt e r na t i o na l Se ps i s Fo r u m . A s y s t e ma t i c r e v i e w o f t he l i t e r a t u r e wa s u nd e r t o ok，a n d t he r e po r t e d r e s ul t s

    wer e gr a de d i nt o f i v e l e v e l s t o c r e a t e r e c o mme nd at i on gr a d i n g f r o m A t o E，wi t h a be i ng t h e hi gh es t g r a d e.

    Re s ul t s I t i s es s e nt i a l t o c ont r ol t he p r i ma r y di s e a s e i n AI I / ARDS. Ro l e of no ni n va s i v e po s i t i v e — p r e s s u r e

    v e nt i l a t i o n i n ALI / ARDS i s u nd ef i ne d.No ni nv as i v e po s i t i v e— pr e s s ur e ve n t i l a t i on c an not b e c ons i d er e d i n

    pa t i e nt s wi t h c o ma，s h oc k a nd da ma g e of a i r wa y c l e a r a nc e .Li m i t at i o n of en d— i ns pi r a t or y p l a t e au p r es s ur e i s

    i mpor t a nt i n t he ma n ag e me nt o f ARDS an d ma y be f a c i l i t a t e d by p er m i s s i v e hy pe r c ap ni a. Re c r u i t me nt

    ma n euv e r s h oul d be c o ns i de r e d t o op e n c o l l a ps e d l un g a nd i mpr ov e o xy ge na t i on. A m i ni mum a m o unt of

    p os i t i ve e nd — e x pi r a t or y pr e s s u r e ( PEEP)s hou l d be s e t t o pr e v e nt a t e l e c t a s i s a t e nd e xp i r a t i o n i n ARDS.I f i t

    i s p os s i bl e ......