肺表面活性物质吸入NO治疗ALIARDS

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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孙波复旦大学儿科医院ClinicalEpidemiologyofARDSinChinaSurfactantandiNOinTreatmentofARDSBoSun,MD,PhDChildren’sHospitalofFudanUniversity2005-03-19BeijingClinicalepidemiologyofALI/ARDSIncidenceofrespiratoryfailure,mechanicalvent

2、ilation,andALI/ARDSinICUStandarddiagnosisandcaremanagementClinicaltrial,controlandinterventionFollowupoutcomesAssesscost-effectivenessMedicalresources,network上海市医院急性呼吸窘迫综合征临床发病情况调查A12-MonthSurveyofARDSinAdultICUsShanghaiARDSStudyGroupIntensiveCareMed

3、2004;30(12):2197-2203Morbidity15PICUs,5320admissions/2001-2002(12mon)108ARDS(2%ofadmission)(Europe6-7%)>15yearsold>24hofadmission,<7daysofprimaryinsult1994AECC:ARDSPaO2/FiO2(mmHg)111+40APACHEII17.3+8LIS>2.5(n)33IntensiveCareMed2004;30(12):2197-2203Mo

4、rtalityDeath:74(68.5%)in-hospital76(70.4%)at3monthsafteronsetDeathrate(病死率)ICUtotaldeath548/5320(10.3%)ARDS/ICUtotaldeath74/548(13.5%)ARDS:non-ARDS6.4:1(RR)IntensiveCareMed2004;30(12):2197-2203PredisposingfactorsofARDSDeathPulmonaryorigin41(39%)32-Pn

5、eumonia37(34.3%)29Non-pulmonary67(61%)42-Sepsis33(30.6%)MODS44/74(60%)Respiratoryfailure17/74(23%)Septicshock9/74(12%)IntensiveCareMed2004;30(12):2197-2203PediatricARDSA12-monthsurveyofincidence,managementandoutcomeofARDSin25pediatricICUinChinaChines

6、ePediatricARDSStudyGroupATS2005SanDiegoInt’lConference北京儿童医院首都儿研所儿童医院北京大学第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PICUal

7、ladmissionsCriticalALI/ARDSSurvivaldeathPIM+Guide1994AECCTreatment基本流程25PediatricICU2004.01-12PICUtotal11453Critical6839RF呼吸衰竭1862MV1883ALI303ARDS97ResultsIncidence/PICUadmissionARDS患病率1.42%ALI患病率4.4%DeathrateARDS病死率62.9%(61)TotalPICU6.8%RRARDS:non-A

8、RDS8.3:1Cost:ARDS/non-ARDS4.5:1PredisposingfactorsofpediatricARDSPneumonia40Sepsis14Immunocompromised15Intoxication8Post-operation4Trauma4Asphyxia3Others11MeasurementtoreducemortalityEarlydiagnosisandmanagementVentilation:lowtidalvolumeSpecifictherap