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中华危重症医学杂志(电子版) ›› 2025, Vol. 18 ›› Issue (04) : 337 -344. doi: 10.3877/cma.j.issn.1674-6880.2025.04.013

综述

孕产妇脓毒症急性呼吸窘迫综合征的诊治进展
赖奕欢1, 杨颖1, 何笑波1, 范远航1, 陈敦金2, 王懿春1,()   
  1. 1510150 广州,广东省产科重大疾病重点实验室/广东省妇产疾病临床医学研究中心/广州医科大学附属第三医院重症医学科
    2510150 广州,广东省产科重大疾病重点实验室/广东省妇产疾病临床医学研究中心/广州医科大学附属第三医院妇产科
  • 收稿日期:2024-09-09 出版日期:2025-08-31
  • 通信作者: 王懿春
  • 基金资助:
    广州市重点研发项目(2023B01J1002); 广州市科技局基金项目(2023A03J0388、2023A03J0389)
  • Received:2024-09-09 Published:2025-08-31
引用本文:

赖奕欢, 杨颖, 何笑波, 范远航, 陈敦金, 王懿春. 孕产妇脓毒症急性呼吸窘迫综合征的诊治进展[J/OL]. 中华危重症医学杂志(电子版), 2025, 18(04): 337-344.

表1 2012年AECC会议柏林标准[3]与2023年ARDS全球新定义诊断标准[17]
参数 2012年柏林标准 2023年全球ARDS新定义
发病时间 在原有疾病基础上7 d内发生的急性或进行性加重的呼吸困难 在危险因素预估出现或者出现新的或恶化的呼吸道症状1周内,低氧性呼吸衰竭急性发作或恶化
胸部影像学 胸部CT或X线提示双肺致密影,不能完全用胸腔积液、肺不张或肺结节解释 胸部X线和CT上双肺阴影,或者超声双肺B线和/或实变,不能完全用积液、肺不张或结节/肿块来解释
危险因素/肺水肿的来源 呼吸衰竭不能完全用心力衰竭、容量过负荷来解释 由急性风险因素引发,如肺炎、非肺部感染、创伤、输血、误吸或休克。肺水肿不完全或主要归因于心源性肺水肿/液体超负荷,低氧血症/气体交换异常也不主要归因于肺不张。然而,如果存在ARDS的易感风险因素,则可以在存在这些条件的情况下诊断ARDS
氧合指数 在机械通气参数PEEP / CPAP不小于5 cmH2O的条件下:
轻度:200 mmHg < PaO2 / FiO2 ≤ 300 mmHg;
中度:100 mmHg < PaO2 / FiO2 ≤ 200 mmHg;
重度:PaO2 / FiO2 ≤ 100 mmHg
非插管患者:
PaO2 / FiO2 ≤ 300 mmHg或SpO2 / FiO2 ≤ 315(SpO2 ≤ 97%),且使用HFNO时氧流量≥ 30 L / min或NIV / CPAP呼吸压力为5 cmH2O。
插管患者:
轻度:200 mmHg < PaO2 / FiO2 ≤ 300 mmHg或235 < SpO2 / FiO2 ≤ 315(SpO2 ≤ 97%);
中度:100 mmHg < PaO2 / FiO2 ≤ 200 mmHg或148 < SpO2 / FiO2 ≤ 235(SpO2 ≤ 97%);
重度:PaO2 / FiO2 ≤ 100 mmHg或SpO2 / FiO2 ≤ 148(SpO2 ≤ 97%)。
资源有限环境下的ARDS:
SpO2 / FiO2 ≤ 315(SpO2 ≤ 97%),在资源有限的情况下,诊断不需要PEEP或最小氧流量
表2 ARDS孕妇的机械通气参数和建议管理策略[44]
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