51阅读吧 - 为您打造专业优质的文章分享平台!
您的当前位置: 51阅读吧 >

投稿指南|material letters 投稿指南

NO.1 material letters 投稿指南

MATERIALS LETTERS

An interdisciplinary journal devoted to rapid communications on the science,applications, and processing of materials.

AUTHOR INFORMATION PACK

TABLE OF CONTENTS? Description? Audience? Impact Factor? Abstracting and Indexing? Editorial Board? Guide for Authorsp.1p.1p.1p.2p.2

p.4

ISSN: 0167-577XDESCRIPTION

Materials Letters is dedicated to publishing novel, cutting edge reports of broad interest to thematerials community. The journal provides a forum for materials scientists and engineers, physicists,and chemists to rapidly communicate on the most important topics in the field in materials.Contributions include, but are not limited to, a variety of topics such as:

? Materials - Metals and alloys, amorphous solids, ceramics, composites, polymers, semiconductors? Applications - Structural, opto-electronic, magnetic, medical, MEMS, sensors, smart? Characterization - Analytical, microscopy, scanning probes, nanoscopic, optical, electrical,magnetic, acoustic, spectroscopic, diffraction? Novel Materials - Micro and nanostructures (nanowires, nanotubes, nanoparticles),nanocomposites, thin films, superlattices, quantum dots.? Processing - Crystal growth, thin film processing, sol-gel processing, mechanical processing,assembly, nanocrystalline processing.? Properties - Mechanical, magnetic, optical, electrical, ferroelectric, thermal, interfacial, transport,thermodynamic? Synthesis - Quenching, solid state, solidification, solution synthesis, vapor deposition, highpressure, explosiveAUDIENCE

Materials scientists, metallurgists, solid state chemists and physicistsIMPACT FACTOR

2010: 2.117 ? Thomson Reuters Journal Citation Reports 2011

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet

1

materialsletters material letters 投稿指南

ABSTRACTING AND INDEXING

Ceramic AbstractsChemical AbstractsCurrent Contents/Engineering, Computing & TechnologyCurrent Contents/Physics, Chemical, & Earth SciencesEl Compendex PlusEngineering IndexFIZ KarlsruheINSPECMaterials Science Citation IndexMetal Abstracts (ASM International – Materials InformationScience Citation IndexScopusEDITORIAL BOARD

Editor-in-Chief

A.R. Boccaccini, Dept. of Materials Science & Engineering, Institute for Biomaterials, Friedrich-Alexander-Universit?t Erlangen-Nürnberg, Cauerstr. 6, 91058 Erlangen, Germany, Email: aldo.boccaccini@ww.uni-erlangen.de

Editors

J. Hojo, Dept. of Applied Chemistry, Kyushu University, 744 Motooka, Nishi-ku, 819-0395 Fukuoka, Japan,Email: mlett@cstf.kyushu-u.ac.jpEvangelos Manias, Dept. of Materials Science and Engineering, Penn State University, 325-D Steidle Building,University Park, 16802, USA, Email: matlet@plmsc.psu.eduT.G. Nieh, Dept. of Materials Science and Engineering, University of Tennessee, Dougherty Engineering Building,Knoxville, TN 37996-2200, USA, Email: tnieh@utk.eduL.S. Shvindlerman, Inst. für Metallkunde und Metallphysik, Rheinisch-Westf?lische Technische HochschuleAachen (RWTH), Kopernikusstr. 14, D-52056 Aachen, Germany, Email: shvind@imm.rwth-aachen.deA.F.W. Willoughby, Engineering Materials, University of Southampton, University Road, Highfield,Southampton, SO17 1BJ, UK, Email: A.F.Willoughby@soton.ac.uk

Associate Editorial Board

M. Baxendale, London, England, UKA. Bellosi, Faenza, ItalyB. Bokstein, Moscow, Russian FederationM. Cinibulk, Dayton, OH, USAP. Colombo, Padova, ItalyJ. Dickerson, Nashville, TN, USAW Fahrenholtz, Rolla, MO, USAH. Gleiter, Karlsruhe, GermanyT. Goto, Aoba, Sendai, JapanD.C. Greenspan, Gainesville, FL, USAA. Hozumi, Nagoya, Aichi, JapanV.V. Kharton, Aveiro, PortugalJ.A. Kilner, London, UKM. Lanagan, University Park, PA, USAX.G. Li, Hefei, Anhui, ChinaZ.G. Liu, Nanjing, ChinaT. Lopez, Mexico D.F., MexicoZ.P. Lu, Beijing, ChinaX.L. Ma, Shenyang, ChinaJ. F. Mano, Guimar?es, PortugalV. Novikov, Moscow, Russian FederationP. Reed, Highfield, Southampton, UKY. Sakka, Ibaraki, JapanM. Sayer, Kingston, ON, CanadaJ. Shen, Chandler, AZ, USAT. Siegrist, Tallahassee, FL, USAN. A. Stolwijk, Münster, GermanyY. Sugahara, Tokyo, JapanW.B. White, University Park, PA, USA

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet2

materialsletters material letters 投稿指南

Y.-F. Zheng, Beijing, ChinaC. Zollfrank, Erlangen, GermanyFounding Editor:

F.F.Y. Wang,

Editor Emeritus:

J.H. Wernick,

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet3

materialsletters material letters 投稿指南

GUIDE FOR AUTHORS

INTRODUCTION

Aims and Scope

Materials Letters is dedicated to publishing novel, cutting edge reports of broad interest to thematerials community. The journal provides a forum for materials scientists and engineers, physicists,and chemists to rapidly communicate on the most important topics in the field in materials. We areprimarily interested in those contributions which bring new insights, and papers will be selected onthe basis of the importance of the new knowledge they provide.

51阅读吧提醒您本文地址:

Contributions include a variety of topics such as:

? Materials - Metals and alloys, amorphous solids, ceramics, composites, nanocrystals, polymers,semiconductors.? Applications - Structural, opto-electronic, magnetic, medical, MEMS, sensors, smart, biomaterials.? Characterization - Analytical, microscopy, scanning probes, nanoscopic, optical, electrical,acoustic, spectroscopic, diffraction.? Novel Materials - Micro and nanostructures (nanowires, nanotubes, nanoparticles),nanocomposites, thin films, superlattices, quantum dots.? Processing - Thin film processing, sol-gel processing, mechanical processing, assembly, andnanocrystalline processing leading to unique materials.? Properties - Mechanical, magnetic, optical, electrical, ferroelectric, thermal, interfacial, transport,thermodynamic.? Synthesis - Quenching, solid state, solidification, solution synthesis, vapor deposition, and highpressure, explosive processes leading to unique materials.

The following topics are inappropriate for publication:

Building materials - aggregate, asphalt, cement, concrete, plasterCatalytic materialsCorrosion and oxidation phenomena and protectionLiquid crystalsMetallurgical ProcessesNatural raw materials ? clays, minerals, rocksOxide glasses and glass ceramicsRecycled materialsRefractoriesSingle crystal growthTheoryWear

Types of Contribution

Letters are intended as brief reports of significant, original and timely research results on the science,applications and processing of materials which warrant rapid publication. In considering a manuscriptfor publication, particular attention will be given to the originality of the research, the desirability ofspeedy publication, the clarity of the presentation and the validity of the conclusions. There is a strictfour-page limit to printed articles. Manuscripts must not exceed 2000 words plus three figures andone table. The maximum number of figures is strictly limited to five. If the maximum of 5 figures isused, then the total number of words must be reduced to 1600. If more than 5 figures are used, themanuscript will be rejected. The manuscript submitted for review should not exceed 8 pages(including title, abstract, references, figures, tables and figure captions).

Contact Details

Authors should submit their article via the online submission system. Authors will be asked to choosethe Editor whose subject area is most closely aligned to the subject of their article. Each Editor'sspecialties are given below. To expedite the review process, authors will also be prompted to nominate3 potential referees, who are not at the same institute, to serve as potential referees. Contact detailsare helpful.

Principal Editors

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet4

materialsletters material letters 投稿指南

Prof. Aldo Boccaccini, Editor in chief - Biomaterials, Glasses and Ceramics, Materials Processing,Porous Materials, Biocomposites, Mechanical PropertiesEvangelos Manias - Featured Letters, Polymers, Organic Materials, Polymer-Matrix (nano)CompositesProf. J. Hojo - Nano-composites, Composites, Sol-gel preparationProf. T.G. Nieh - Metallic Alloys, Ceramics, Composites, High Temperature Materials, MechanicalBehavior, Material ProcessingProf. L.S. Shvindlerman - Nano-Crystalline Metals, Thermodynamics, Kinetics, Interfaces andSurfaces.Prof. A.F.W. Willoughby - Semiconductor/Electronic Materials, Polymers

BEFORE YOU BEGIN

Online Submission

Authors must submit their articles using the secure online submission system athttp://ees.elsevier.com/mlblue.

To facilitate rapid publication, it is essential to precisely follow these instructions. Failure to do so canresult in a delay or rejection of the manuscript for publication.

To ensure a timely review you will be required to answer the following questions before your paperwill be considered for review.

? Has your paper, or part of your paper, been published before, or is it currently submitted for reviewto another journal?Yes / No(If yes, then do not submit your paper to Materials Letters.)

? Is the total number of words less than 2000?Yes / No(If greater than 2000, please reduce the number of words.)

? Is the number of figures greater than 5?Yes / No(If yes, then the paper will automatically be rejected.)

? Are the x-ray diffraction patterns indexed?Yes / NoX-ray diffraction patterns should be indexed. (If your x-ray patterns are not indexed, the paper willbe rejected for publication.)

? Do the micrographs have professional quality scale markers?Yes / NoProfessional scale bars should be added to micrographs; the bar included in the micrograph printoutis not sufficient.(Please replace the black bar on SEM & TEM micrographs with a professional quality scale marker.)Ethics in publishing

For information on Ethics in publishing and Ethical guidelines for journal publication seehttp://www.elsevier.com/publishingethics and

Policy and ethics

The work described in your article must have been carried out in accordance with The Codeof Ethics of the World Medical Association (Declaration of Helsinki) for experiments involvinghumans ; EU Directive 2010/63/EUfor animal experiments ;Uniform Requirements for manuscripts submitted to Biomedical journals http://www.icmje.org. Thismust be stated at an appropriate point in the article.

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet5

materialsletters material letters 投稿指南

Conflict of interest

All authors are requested to disclose any actual or potential conflict of interest including any financial,personal or other relationships with other people or organizations within three years of beginning thesubmitted work that could inappropriately influence, or be perceived to influence, their work. Seealso http://www.elsevier.com/conflictsofinterest.

Submission declaration

Submission of an article implies that the work described has not been published previously (exceptin the form of an abstract or as part of a published lecture or academic thesis), that it is not underconsideration for publication elsewhere, that its publication is approved by all authors and tacitly orexplicitly by the responsible authorities where the work was carried out, and that, if accepted, itwill not be published elsewhere including electronically in the same form, in English or in any otherlanguage, without the written consent of the copyright-holder.

Changes to authorship

This policy concerns the addition, deletion, or rearrangement of author names in the authorship ofaccepted manuscripts:Before the accepted manuscript is published in an online issue: Requests to add or remove an author,or to rearrange the author names, must be sent to the Journal Manager from the corresponding authorof the accepted manuscript and must include: (a) the reason the name should be added or removed,or the author names rearranged and (b) written confirmation (e-mail, fax, letter) from all authors thatthey agree with the addition, removal or rearrangement. In the case of addition or removal of authors,this includes confirmation from the author being added or removed. Requests that are not sent bythe corresponding author will be forwarded by the Journal Manager to the corresponding author, whomust follow the procedure as described above. Note that: (1) Journal Managers will inform the JournalEditors of any such requests and (2) publication of the accepted manuscript in an online issue issuspended until authorship has been agreed.After the accepted manuscript is published in an online issue: Any requests to add, delete, or rearrangeauthor names in an article published in an online issue will follow the same policies as noted aboveand result in a corrigendum.

Copyright

Upon acceptance of an article, authors will be asked to complete a 'Journal Publishing Agreement' (formore information on this and copyright see http://www.elsevier.com/copyright). Acceptance of theagreement will ensure the widest possible dissemination of information. An e-mail will be sent tothe corresponding author confirming receipt of the manuscript together with a 'Journal PublishingAgreement' form or a link to the online version of this agreement.Subscribers may reproduce tables of contents or prepare lists of articles including abstracts for internalcirculation within their institutions. Permission of the Publisher is required for resale or distributionoutside the institution and for all other derivative works, including compilations and translations(please consult http://www.elsevier.com/permissions). If excerpts from other copyrighted works areincluded, the author(s) must obtain written permission from the copyright owners and credit thesource(s) in the article. Elsevier has preprinted forms for use by authors in these cases: please consulthttp://www.elsevier.com/permissions.

Retained author rights

As an author you (or your employer or institution) retain certain rights; for details you are referredto: http://www.elsevier.com/authorsrights.

Role of the funding source

You are requested to identify who provided financial support for the conduct of the research and/orpreparation of the article and to briefly describe the role of the sponsor(s), if any, in study design; inthe collection, analysis and interpretation of data; in the writing of the report; and in the decision tosubmit the article for publication. If the funding source(s) had no such involvement then this shouldbe stated. Please see http://www.elsevier.com/funding.

Funding body agreements and policies

Elsevier has established agreements and developed policies to allow authors whose articles appear injournals published by Elsevier, to comply with potential manuscript archiving requirements as specifiedas conditions of their grant awards. To learn more about existing agreements and policies please visit

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet6

materialsletters material letters 投稿指南

Open access

This journal offers you the option of making your article freely available to all via the ScienceDirectplatform. To prevent any conflict of interest, you can only make this choice after receiving notificationthat your article has been accepted for publication. The fee of $3,000 excludes taxes and otherpotential author fees such as color charges. In some cases, institutions and funding bodies haveentered into agreement with Elsevier to meet these fees on behalf of their authors. Details of theseagreements are available at http://www.elsevier.com/fundingbodies. Authors of accepted articles,who wish to take advantage of this option, should complete and submit the order form (available athttp://www.elsevier.com/locate/openaccessform.pdf). Whatever access option you choose, you retainmany rights as an author, including the right to post a revised personal version of your article on yourown website. More information can be found here: http://www.elsevier.com/authorsrights .Language and language services

Please write your text in good English (American or British usage is accepted, but not a mixture ofthese). Authors who require information about language editing and copyediting services pre- andpost-submission please visit http://webshop.elsevier.com/languageservices or our customer supportsite at http://support.elsevier.com for more information.

Submission

Submission to this journal proceeds totally online and you will be guided stepwise through the creationand uploading of your files. The system automatically converts source files to a single PDF file of thearticle, which is used in the peer-review process. Please note that even though manuscript sourcefiles are converted to PDF files at submission for the review process, these source files are needed forfurther processing after acceptance. All correspondence, including notification of the Editor's decisionand requests for revision, takes place by e-mail removing the need for a paper trail.

Referees

Please submit, with the manuscript, the names, addresses and e-mail addresses of three potentialreferees. Note that the editor retains the sole right to decide whether or not the suggested reviewersare used.

PREPARATION

Use of wordprocessing software

It is important that the file be saved in the native format of the wordprocessor used. The text shouldbe in single-column format. Keep the layout of the text as simple as possible. Most formatting codeswill be removed and replaced on processing the article. In particular, do not use the wordprocessor'soptions to justify text or to hyphenate words. However, do use bold face, italics, subscripts,superscripts etc. When preparing tables, if you are using a table grid, use only one grid for eachindividual table and not a grid for each row. If no grid is used, use tabs, not spaces, to align columns.The electronic text should be prepared in a way very similar to that of conventional manuscripts(see also the Guide to Publishing with Elsevier: http://www.elsevier.com/guidepublication). Note thatsource files of figures, tables and text graphics will be required whether or not you embed your figuresin the text. See also the section on Electronic artwork.To avoid unnecessary errors you are strongly advised to use the 'spell-check' and 'grammar-check'functions of your wordprocessor.

Article structure

Follow this order when submitting manuscripts: Title, Authors, Affiliations, Abstract, Keywords, Maintext, Acknowledgements, Appendix, References, Figure Captions and then Tables. For submission viathe website you are requested to import low-resolution images into the article at the approximatelocation you wish them to appear. Thus the PDF which is created for refereeing purposes will containall necessary information. In addition you will be asked to separately upload high quality images.Collate acknowledgements in a separate section at the end of the article and do not include them onthe title page, as a footnote to the title or otherwise.

Text Layout

Use double spacing and wide (3 cm) margins. (Avoid full justification, i.e., do not use a constantright-hand margin.) Ensure that each new paragraph is clearly indicated. Present tables, figures andfigure legends at the point they will appear in the manuscript. If possible, consult a recent issue ofthe journal to become familiar with layout and conventions. Number all pages consecutively, use 12or 10 pt font size and standard fonts.

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet7

materialsletters material letters 投稿指南

Subdivision - numbered sectionsDivide your article into clearly defined and numbered sections. Subsections should be numbered1.1 (then 1.1.1, 1.1.2, ...), 1.2, etc. (the abstract is not included in section numbering). Use thisnumbering also for internal cross-referencing: do not just refer to 'the text'. Any subsection may begiven a brief heading. Each heading should appear on its own separate line.

51阅读吧提醒您本文地址:

IntroductionState the objectives of the work and provide an adequate background, avoiding a detailed literaturesurvey or a summary of the results.

Material and methodsProvide sufficient detail to allow the work to be reproduced. Methods already published should beindicated by a reference: only relevant modifications should be described.

Theory/calculationA Theory section should extend, not repeat, the background to the article already dealt with in theIntroduction and lay the foundation for further work. In contrast, a Calculation section represents apractical development from a theoretical basis.

ResultsResults should be clear and concise.

DiscussionThis should explore the significance of the results of the work, not repeat them. A combined Resultsand Discussion section is often appropriate. Avoid extensive citations and discussion of publishedliterature.

ConclusionsThe main conclusions of the study may be presented in a short Conclusions section, which may standalone or form a subsection of a Discussion or Results and Discussion section.

Essential title page information

? Title. Concise and informative. Titles are often used in information-retrieval systems. Avoidabbreviations and formulae where possible.? Author names and affiliations. Where the family name may be ambiguous (e.g., a doublename), please indicate this clearly. Present the authors' affiliation addresses (where the actual workwas done) below the names. Indicate all affiliations with a lower-case superscript letter immediatelyafter the author's name and in front of the appropriate address. Provide the full postal address ofeach affiliation, including the country name and, if available, the e-mail address of each author.? Corresponding author. Clearly indicate who will handle correspondence at all stages of refereeingand publication, also post-publication. Ensure that telephone and fax numbers (with countryand area code) are provided in addition to the e-mail address and the complete postaladdress. Contact details must be kept up to date by the corresponding author.? Present/permanent address. If an author has moved since the work described in the articlewas done, or was visiting at the time, a 'Present address' (or 'Permanent address') may be indicatedas a footnote to that author's name. The address at which the author actually did the work must beretained as the main, affiliation address. Superscript Arabic numerals are used for such footnotes.Abstract

A self-contained abstract of 100 to 200 words, outlining in a single paragraph the aims, scope andconclusions of the paper must be supplied. Do not list the analytical equipment (e.g. SEM, XRD, TEM)used unless it is critical to the meaning. The abstract should state briefly the purpose of the research,the principal results and major conclusions. An abstract is often presented separate from the article,so it must be able to stand alone. For this reason, References should be avoided, but if essential,they must be cited in full, without reference to the reference list. Also, non-standard or uncommonabbreviations should be avoided, but if essential they must be defined at their first mention in theabstract itself.

Graphical abstract

A Graphical abstract is optional and should summarize the contents of the article in a concise, pictorialform designed to capture the attention of a wide readership online. Authors must provide imagesthat clearly represent the work described in the article. Graphical abstracts should be submitted as aseparate file in the online submission system. Image size: Please provide an image with a minimumAUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet8

materialsletters material letters 投稿指南

of 531 × 1328 pixels (h × w) or proportionally more. The image should be readable at a size of 5 ×13 cm using a regular screen resolution of 96 dpi. Preferred file types: TIFF, EPS, PDF or MS Officefiles. See http://www.elsevier.com/graphicalabstracts for examples.Authors can make use of Elsevier's free Graphical abstract check to ensure the best display of theresearch in accordance with our technical requirements. 24-hour Graphical abstract check

Highlights

Highlights are mandatory for this journal. They consist of a short collection of bullet points that conveythe core findings of the article and should be submitted in a separate file in the online submissionsystem. Please use 'Highlights' in the file name and include 3 to 5 bullet points (maximum 85characters, including spaces, per bullet point). See http://www.elsevier.com/highlights for examples.Keywords

Immediately after the abstract, provide a maximum of 6 keywords, using American spelling andavoiding general and plural terms and multiple concepts (avoid, for example, 'and', 'of'). Be sparingwith abbreviations: only abbreviations firmly established in the field may be eligible. These keywordswill be used for indexing purposes.

51阅读吧提醒您本文地址:

Acknowledgements

Collate acknowledgements in a separate section at the end of the article before the references and donot, therefore, include them on the title page, as a footnote to the title or otherwise. List here thoseindividuals who provided help during the research (e.g., providing language help, writing assistanceor proof reading the article, etc.).

Nomenclature and units

Follow internationally accepted rules and conventions: use the international system of units (SI).If other quantities are mentioned, give their equivalent in SI. You are urged to consult IUGS:Nomenclature for geological time scales/rock names: http://www.iugs.org/ for further information.Math formulae

Present simple formulae in the line of normal text where possible and use the solidus (/) instead ofa horizontal line for small fractional terms, e.g., X/Y. In principle, variables are to be presented initalics. Powers of e are often more conveniently denoted by exp. Number consecutively any equationsthat have to be displayed separately from the text (if referred to explicitly in the text).

Artwork

Electronic artworkGeneral points? Make sure you use uniform lettering and sizing of your original artwork.? Save text in illustrations as 'graphics' or enclose the font.? Only use the following fonts in your illustrations: Arial, Courier, Times, Symbol.? Number the illustrations according to their sequence in the text.? Use a logical naming convention for your artwork files.? Provide captions to illustrations separately.? Produce images near to the desired size of the printed version.? Submit each figure as a separate file.

A detailed guide on electronic artwork is available on our website:http://www.elsevier.com/artworkinstructionsYou are urged to visit this site; some excerpts from the detailed information are given here.FormatsRegardless of the application used, when your electronic artwork is finalised, please 'save as' orconvert the images to one of the following formats (note the resolution requirements for line drawings,halftones, and line/halftone combinations given below):EPS: Vector drawings. Embed the font or save the text as 'graphics'.TIFF: Color or grayscale photographs (halftones): always use a minimum of 300 dpi.TIFF: Bitmapped line drawings: use a minimum of 1000 dpi.TIFF: Combinations bitmapped line/half-tone (color or grayscale): a minimum of 500 dpi is required.If your electronic artwork is created in a Microsoft Office application (Word, PowerPoint, Excel) thenplease supply 'as is'.Please do not:? Supply files that are optimised for screen use (e.g., GIF, BMP, PICT, WPG); the resolution is too low;? Supply files that are too low in resolution;

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet9

materialsletters material letters 投稿指南

? Submit graphics that are disproportionately large for the content.

Color artworkPlease make sure that artwork files are in an acceptable format (TIFF, EPS or MS Office files) and withthe correct resolution. If, together with your accepted article, you submit usable color figures thenElsevier will ensure, at no additional charge, that these figures will appear in color on the Web (e.g.,ScienceDirect and other sites) regardless of whether or not these illustrations are reproduced in colorin the printed version. For color reproduction in print, you will receive information regardingthe costs from Elsevier after receipt of your accepted article. Please indicate your preferencefor color: in print or on the Web only. For further information on the preparation of electronic artwork,please see http://www.elsevier.com/artworkinstructions.Please note: Because of technical complications which can arise by converting color figures to 'grayscale' (for the printed version should you not opt for color in print) please submit in addition usableblack and white versions of all the color illustrations.

Figure captionsEnsure that each illustration has a caption. Supply captions separately, not attached to the figure. Acaption should comprise a brief title (not on the figure itself) and a description of the illustration. Keeptext in the illustrations themselves to a minimum but explain all symbols and abbreviations used.Tables

Number tables consecutively in accordance with their appearance in the text. Place footnotes to tablesbelow the table body and indicate them with superscript lowercase letters. Avoid vertical rules. Besparing in the use of tables and ensure that the data presented in tables do not duplicate resultsdescribed elsewhere in the article.

References

Citation in textPlease ensure that every reference cited in the text is also present in the reference list (and viceversa). Any references cited in the abstract must be given in full. Unpublished results and personalcommunications are not recommended in the reference list, but may be mentioned in the text. If thesereferences are included in the reference list they should follow the standard reference style of thejournal and should include a substitution of the publication date with either 'Unpublished results' or'Personal communication' Citation of a reference as 'in press' implies that the item has been acceptedfor publication.

51阅读吧提醒您本文地址:

Web referencesAs a minimum, the full URL should be given and the date when the reference was last accessed. Anyfurther information, if known (DOI, author names, dates, reference to a source publication, etc.),should also be given. Web references can be listed separately (e.g., after the reference list) under adifferent heading if desired, or can be included in the reference list.

References in a special issuePlease ensure that the words 'this issue' are added to any references in the list (and any citations inthe text) to other articles in the same Special Issue.

Reference management softwareThis journal has standard templates available in key reference managementpackages EndNote (http://www.endnote.com/support/enstyles.asp) and Reference Manager(http://refman.com/support/rmstyles.asp). Using plug-ins to wordprocessing packages, authors onlyneed to select the appropriate journal template when preparing their article and the list of referencesand citations to these will be formatted according to the journal style which is described below.Reference styleText: Indicate references by number(s) in square brackets in line with the text. The actual authorscan be referred to, but the reference number(s) must always be given.List: Number the references (numbers in square brackets) in the list in the order in which they appearin the text.Examples:Reference to a journal publication:[1] Van der Geer J, Hanraads JAJ, Lupton RA. The art of writing a scientific article. J Sci Commun2010;163:51–9.Reference to a book:[2] Strunk Jr W, White EB. The elements of style. 4th ed. New York: Longman; 2000.

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet10

materialsletters material letters 投稿指南

Reference to a chapter in an edited book:[3] Mettam GR, Adams LB. How to prepare an electronic version of your article. In: Jones BS, SmithRZ, editors. Introduction to the electronic age, New York: E-Publishing Inc; 2009, p. 281–304.Note shortened form for last page number. e.g., 51–9, and that for more than 6 authors the first6 should be listed followed by 'et al.' For further details you are referred to 'Uniform Requirementsfor Manuscripts submitted to Biomedical Journals' (J Am Med Assoc 1997;277:927–34) (see also).

Journal abbreviations sourceJournal names should be abbreviated according toIndex Medicus journal abbreviations: ;List of title word abbreviations: http://www.issn.org/2-22661-LTWA-online.php;CAS (Chemical Abstracts Service): .

Video data

Elsevier accepts video material and animation sequences to support and enhance your scientificresearch. Authors who have video or animation files that they wish to submit with their article arestrongly encouraged to include these within the body of the article. This can be done in the same wayas a figure or table by referring to the video or animation content and noting in the body text where itshould be placed. All submitted files should be properly labeled so that they directly relate to the videofile's content. In order to ensure that your video or animation material is directly usable, please providethe files in one of our recommended file formats with a preferred maximum size of 50 MB. Video andanimation files supplied will be published online in the electronic version of your article in ElsevierWeb products, including ScienceDirect: http://www.sciencedirect.com. Please supply 'stills' with yourfiles: you can choose any frame from the video or animation or make a separate image. These willbe used instead of standard icons and will personalize the link to your video data. For more detailedinstructions please visit our video instruction pages at http://www.elsevier.com/artworkinstructions.Note: since video and animation cannot be embedded in the print version of the journal, pleaseprovide text for both the electronic and the print version for the portions of the article that refer tothis content.

Supplementary data

Figures and text submitted as supplementary material must contain only material that issupportive of the main text, and not material that is inherent to the essential meaning of thearticle. Papers with reference to supplementary material, which the Editors find necessaryto include as main text, will be sent back to authors.Elsevier accepts electronic supplementary material to support and enhance your scientific research.Supplementary files offer the author additional possibilities to publish supporting applications, high-resolution images, background datasets, sound clips and more. Supplementary files supplied will bepublished online alongside the electronic version of your article in Elsevier Web products, includingScienceDirect: http://www.sciencedirect.com. In order to ensure that your submitted material isdirectly usable, please provide the data in one of our recommended file formats. Authors shouldsubmit the material in electronic format together with the article and supply a concise and descriptivecaption for each file. For more detailed instructions please visit our artwork instruction pages at

Submission checklist

The following list will be useful during the final checking of an article prior to sending it to the journalfor review. Please consult this Guide for Authors for further details of any item.Ensure that the following items are present:One author has been designated as the corresponding author with contact details:? E-mail address? Full postal address? Telephone and fax numbersAll necessary files have been uploaded, and contain:? Keywords? All figure captions? All tables (including title, description, footnotes)Further considerations? Manuscript has been 'spell-checked' and 'grammar-checked'? References are in the correct format for this journal? All references mentioned in the Reference list are cited in the text, and vice versa

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet11

materialsletters material letters 投稿指南

? Permission has been obtained for use of copyrighted material from other sources (including the Web)? Color figures are clearly marked as being intended for color reproduction on the Web (free of charge)and in print, or to be reproduced in color on the Web (free of charge) and in black-and-white in print? If only color on the Web is required, black-and-white versions of the figures are also supplied forprinting purposesFor any further information please visit our customer support site at http://support.elsevier.com.AFTER ACCEPTANCE

Use of the Digital Object Identifier

The Digital Object Identifier (DOI) may be used to cite and link to electronic documents. The DOIconsists of a unique alpha-numeric character string which is assigned to a document by the publisherupon the initial electronic publication. The assigned DOI never changes. Therefore, it is an idealmedium for citing a document, particularly 'Articles in press' because they have not yet received theirfull bibliographic information. The correct format for citing a DOI is shown as follows (example takenfrom a document in the journal Physics Letters B):doi:10.1016/j.physletb.2010.09.059When you use the DOI to create URL hyperlinks to documents on the web, the DOIs are guaranteednever to change.

Proofs

One set of page proofs (as PDF files) will be sent by e-mail to the corresponding author (if we donot have an e-mail address then paper proofs will be sent by post) or, a link will be provided inthe e-mail so that authors can download the files themselves. Elsevier now provides authors withPDF proofs which can be annotated; for this you will need to download Adobe Reader version 7 (orhigher) available free from http://get.adobe.com/reader. Instructions on how to annotate PDF fileswill accompany the proofs (also given online). The exact system requirements are given at the Adobesite: .If you do not wish to use the PDF annotations function, you may list the corrections (includingreplies to the Query Form) and return them to Elsevier in an e-mail. Please list your correctionsquoting line number. If, for any reason, this is not possible, then mark the corrections and any othercomments (including replies to the Query Form) on a printout of your proof and return by fax, or scanthe pages and e-mail, or by post. Please use this proof only for checking the typesetting, editing,completeness and correctness of the text, tables and figures. Significant changes to the article asaccepted for publication will only be considered at this stage with permission from the Editor. We willdo everything possible to get your article published quickly and accurately – please let us have all yourcorrections within 48 hours. It is important to ensure that all corrections are sent back to us in onecommunication: please check carefully before replying, as inclusion of any subsequent correctionscannot be guaranteed. Proofreading is solely your responsibility. Note that Elsevier may proceed withthe publication of your article if no response is received.

Offprints

The corresponding author, at no cost, will be provided with a PDF file of the article via e-mail. For anextra charge, paper offprints can be ordered via the offprint order form which is sent once the articleis accepted for publication. The PDF file is a watermarked version of the published article and includesa cover sheet with the journal cover image and a disclaimer outlining the terms and conditions of use.Keyword List

AdhesionAmorphous materialsAtom probeAtomic force microscopyBiomaterialsBiomimeticCarbon materialsCarbon nanotubesNanoparticlesCastCeramicsBioceramicsFunctionalStructural

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet12

materialsletters material letters 投稿指南

Colloidal processingComposite materialsCeramic compositesMetallic compositesPolymeric compositesCorrosionCreepCrystal growthCrystal structureDefectsDeformation and fractureDepositionChemical vapour depositionElectrodepositionPhysical vapour depositionSputteringDielectricsDiffusionElastic propertiesElectrical propertiesElectroceramicsElectron microscopyElectronic materialsContactsOrganicSemiconductorsEnergy storage and conversionEpitaxial growthFatigueFerroelectricsFibre technologyFullerenesGrain boundariesGrain boundary junctionsIndentation and hardnessInterfacesIntermetallic alloys and compoundsIon beam technologyLaminatesLangmuir-Blodgett filmsLaser processingLuminescenceMagnetic materialsMetal forming and shapingMetallurgyMetals and alloysMultilayer structureMicrostructureNanocompositesNanocrystalline materialsFunctionalStructuralNeutron diffraction and scatteringNuclear materialsOptical materials and propertiesOxidationParticles, nanosizePhase diagramsPhase transformationPhosphors

51阅读吧提醒您本文地址:

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet13

materialsletters material letters 投稿指南

Piezoelectric materialsPolymersPowder technologyPorous materialsPsitron annihilationRadiation damageRecrystallizationScanning tunnelling microscopySegregationSensorsShape memory materialsSimulation and modellingSinteringSolar energy materialsSol-gel preparationSolidificationSpectroscopyFTIRMossbauerRamanXPSSuperconductorsSurfacesTextureThermal analysisThermal propertiesThermodynamics and kinetics of processes in materialsThick filmsThin filmsVaristorsViscoelasticityWear and tribologyWeldingX-ray techniques

AUTHOR INQUIRIES

For inquiries relating to the submission of articles (including electronic submission) pleasevisit this journal's homepage. Contact details for questions arising after acceptance ofan article, especially those relating to proofs, will be provided by the publisher. Youcan track accepted articles at http://www.elsevier.com/trackarticle. You can also checkour Author FAQs (http://www.elsevier.com/authorFAQ) and/or contact Customer Support viahttp://support.elsevier.com.

? Copyright 2011 Elsevier | http://www.elsevier.com

AUTHOR INFORMATION PACK15 Sep 2011www.elsevier.com/locate/matlet14

51阅读吧提醒您本文地址:

NO.2 ARDS指南-10[1].10统稿-END 95

急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)(草案)

中华医学会重症医学分会

编写工作小组成员(按姓氏笔画排序):

前言

急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)是一种常见危重症,病死率极高,严重威胁重症病人的生命并影响其生存质量。尽管我国重症医学已有了长足发展,但对ALI/ARDS的认识和治疗状况尚不容乐观。中华医学会重症医学分会以循证医学证据为基础,采用国际通用的方法,经广泛征求意见和建议,反复认真讨论,达成关于ALI/ARDS诊断和治疗方面的共识,以期对ALI/ARDS诊断和治疗进行规范。中华重症医学分会以后还将根据循证医学证据的发展及新的共识对ALI/ARDS诊断和治疗指南进行更新。 指南中的推荐意见依据2001年国际感染论坛(ISF)提出的Delphi分级标准(表1)[1]。将指南中涉及的文献按照研究方法和结果分成5个层次,推荐意见的推荐级别分为A?E级,其中A级为最高。但需要说明的是推荐等级并不代表特别建议,而只是文献的支持程度。

表1 推荐级别与研究文献的分级

推荐级别

A

B

C

D

E

I

II

III

IV

V 至少有2项I级研究结果支持 仅有1项I级研究结果支持 仅有II级研究结果支持 至少有1项III级研究结果支持 仅有IV级或V研究结果支持 大样本,随机研究,结果清晰,假阳性或假阴性的错误很低 小样本,随机研究,结果不确定,假阳性和/或假阴性的错误较高 非随机,同期控制研究 非随机,历史控制和专家意见 病例报道,非控制研究和专家意见 研究文献的分级

一、ALI/ARDS的概念与流行病学

ALI/ARDS是心源性以外的各种肺内外致病因素导致的急性进行性低氧性呼吸功能不全或衰竭。常发生于严重感染、休克、创伤及烧伤等疾病过程中,肺毛细血管内皮细胞和肺泡上皮细胞损伤导致的弥漫性肺间质及肺泡水肿。以肺容积减少、肺顺应性降低、严重的通气/血流比例失调为病理生理特征,临床上表现为进行性低氧血症和呼吸窘迫,肺部影像学上表现为非均一性的渗出性病变 [2]。

流行病学调查显示ALI/ARDS是临床常见危重症。根据1994年欧美联席会议提出

的ALI/ARDS诊断标准[1],ALI发病率为每年18/10万,ARDS为每年13~23/10万。2005年的研究显示,ALI/ARDS发病率分别在每年79和59/10万[3]。提示ALI/ARDS发病率显著增高,明显增加了社会和经济负担,这甚至可与胸部肿瘤、AIDS、哮喘或心肌梗死等相提并论[4]。

多种危险因素可诱发ALI/ARDS,主要包括:①直接肺损伤因素:严重肺感染,胃内容物吸入,肺挫伤,吸入有毒气体,淹溺、氧中毒等;②间接肺损伤因素:严重感染,严重的非胸部创伤,急性重症胰腺炎,大量输血,体外循环,弥漫性血管内凝血等[2]。

病因不同,ARDS患病率也明显不同。严重感染时ALI/ARDS患病率可高达25%~50%[5],大量输血可达40%,多发性创伤达到11~25%,而严重误吸时,ARDS患病率也可达9~26%[6,7]。同时存在两或三个危险因素时,ALI/ARDS患病率进一步升高。另外,危险因素持续作用时间越长,ALI/ARDS的患病率越高,危险因素持续24、48及72h时,ARDS患病率分别为76%、85%和93%[8]。

虽然不同研究对ARDS病死率的报道差异较大,总体来说,目前ARDS的病死率仍较高。Krafft等将1967~1994年国际正式发表的ARDS临床研究进行荟萃分析,3264例ARDS病人的病死率在50%左右[9]。中国上海市15家成人ICU 2001年3月至2002年3月ARDS病死率也高达68.5%[10]。不同研究中ARDS的病因构成、疾病状态和治疗条件的不同可能是导致ARDS病死率不同的主要原因。

二、ALI/ARDS病理生理与发病机制

ALI/ARDS的基本病理生理改变是肺泡上皮和肺毛细血管内皮通透性增加所致的非心源性肺水肿。由于肺泡水肿、肺泡塌陷导致严重通气/血流比例失调,特别是肺内分流明显增加,从而产生严重的低氧血症。肺血管挛缩和肺微小血栓形成引发肺动脉高压。

ARDS早期的特征性表现为肺毛细血管内皮细胞与肺泡上皮细胞屏障的通透性增高,肺泡与肺间质内积聚大量的水肿液[11],其中富含蛋白及以中性粒细胞为主的多种炎症细胞。中性粒细胞黏附在受损的血管内皮细胞表面,进一步向间质和肺泡腔移行,释放大量促炎介质,如炎症性细胞因子、过氧化物、白三烯、蛋白酶、血小板活化因子等,参与中性粒细胞介导的肺损伤[1]。除炎症细胞外,肺泡上皮细胞以及成纤维细胞也能产生多种细胞因子,从而加剧炎症反应过程。凝血和纤溶紊乱也参与ARDS的病程,ARDS早期促凝机制上调,而纤溶过程受到抑制,引起广泛血栓形成和纤维蛋白的大量沉积[12,13],导致血管堵塞以及微循环结构受损。ARDS早期在病理学上可见弥漫性肺损伤,透明膜形成及I型肺泡上皮或内皮细胞坏死、水肿,II型肺泡上皮细胞增生和间质纤维化等表现[13,14]。

少数ALI/ARDS病人在发病第一周内可缓解,但多数病人在发病的5-7d后病情仍然进展,进入亚急性期。在ALI/ARDS的亚急性期,病理上可见肺间质和肺泡纤维化,II型肺泡上皮细胞增生,部分微血管破坏并出现大量新生血管[15]。部分病人呼吸衰竭持续超过14d,病理上常表现为严重的肺纤维化,肺泡结构破坏和重建。

三、ALI/ARDS的临床特征与诊断

一般认为,ALI/ARDS具有以下临床特征:①急性起病,在直接或间接肺损伤后12-48h

内发病;②常规吸氧后低氧血症难以纠正;③肺部体征无特异性,急性期双肺可闻及湿啰音,或呼吸音减低;④早期病变以间质性为主,胸部X线片常无明显改变。病情进展后,可出现肺内实变,表现为双肺野普遍密度增高,透亮度减低,肺纹理增多、增粗,可见散在斑片状密度增高阴影,即弥漫性肺浸润影;⑤无心功能不全证据。

目前ALI/ARDS诊断仍广泛沿用1994年欧美联席会议提出的诊断标准:①急性起病;②氧合指数(PaO2/FiO2)≤200mmHg[不管呼气末正压(PEEP)水平];③正位X线胸片显示双肺均有班片状阴影;④肺动脉嵌顿压≤18mmHg,或无左心房压力增高的临床证据。如PaO2/FiO2≤300mmHg且满足上述其它标准,则诊断为ALI[2]。

四、ALI/ARDS的治疗

(一)原发病治疗

全身性感染、创伤、休克、烧伤、急性重症胰腺炎等是导致ALI/ARDS的常见病因。严重感染病人约有25%~50%发生ALI/ARDS,而且在感染、创伤等导致的多器官功能障碍(MODS)中,肺往往也是最早发生衰竭的器官。目前认为,感染、创伤后的全身炎症反应是导致ARDS的根本原因[16]。控制原发病,遏制其诱导的全身失控性炎症反应,是预防和治疗ALI/ARDS的重要环节。

推荐意见1:积极控制原发病是遏制ALI/ARDS发展的重要环节 (推荐级别:E级) 7

(二)呼吸支持治疗

1.氧疗

ALI/ARDS病人吸氧治疗的目的改善低氧血症,使动脉血氧分压(PaO2)达到60~80 mmHg[17]。可根据低氧血症改善的程度和治疗反应调整氧疗方式,首先使用鼻导管,当需要较高的吸氧浓度时,应采用可调节吸氧浓度的文丘里面罩或带贮氧袋的非重吸式氧气面罩(可提供高达90%的氧浓度)。ARDS病人往往低氧血症严重,大多数病人一旦诊断明确,常规的氧疗常常难以奏效,机械通气仍然是最主要的呼吸支持手段[18]。

推荐意见2:常规氧疗是纠正ALI/ARDS病人低氧血症的基本手段 (推荐级别:E级)

2.无创机械通气

无创机械通气(NPPV)可以避免气管插管和气管切开引起的并发症,近年来得到了广泛的推广应用。尽管随机对照试验(RCT)证实NPPV治疗慢性阻塞性肺疾病和心源性肺水肿导致的呼吸衰竭的疗效是肯定的,但是NPPV在急性低氧性呼吸衰竭中的应用却存在很多争议。迄今为止,尚无足够的资料显示NPPV可以作为ALI/ARDS导致的急性低氧性呼吸衰竭的常规治疗方法。

不同研究中NPPV对急性低氧性呼吸衰竭的治疗效果差异较大,可能与导致低氧性呼吸衰竭的病因不同有关。2004年一项荟萃分析显示,在不包括慢性阻塞性肺疾病和心源性肺水肿的急性低氧性呼吸衰竭病人中,与标准氧疗相比,NPPV可明显降低气管插管率,并有降低ICU住院时间及住院病死率的趋势。分层分析发现NPPV对ALI/ARDS的疗效不

明确[19]。最近Rana等观察了54例ALI/ARDS病人,应用NPPV后70%病人无效,逐步回归分析显示,休克、严重低氧血症和代谢性酸中毒是ARDS病人NPPV治疗失败的预测指标[20]。Declaux等人的RCT研究显示,与标准氧疗比较,NPPV虽然在应用第一小时明显改善ALI/ARDS病人的氧合,但不能降低气管插管率,也不改善病人预后[21]。可见,ALI/ARDS病人应慎用NPPV。

当ARDS病人神志清楚、血流动力学稳定,并能够得到严密监测和随时可行气管插管时,可以尝试NPPV治疗。Sevransky等建议,在治疗全身性感染引起的ALI/ARDS时,如果预计病人的病情能够在48~72h缓解,可以考虑应用NPPV[22]。

应用NPPV可使部分合并免疫抑制的ALI/ARDS病人避免有创机械通气,从而避免呼吸机相关肺炎(VAP)的发生,并可能改善预后。目前两个小样本RCT研究和一个回顾性研究结果均提示,因免疫抑制导致的急性低氧性呼吸衰竭病人可以从NPPV中获益。对40名实体器官移植的急性低氧性呼吸衰竭病人的RCT研究显示,与标准吸氧治疗相比,NPPV组气管插管率、严重并发症的发生率、入住ICU时间和ICU病死率明显降低,但住院病死率无差别[23]。而对52名免疫抑制合并急性低氧性呼吸衰竭病人(主要是血液肿瘤)的RCT研究也显示,与常规治疗方案比较,NPPV联合常规治疗方案可明显降低气管插管率、ICU病死率和住院病死率也明显减低[24]。对237例机械通气的恶性肿瘤病人进行回顾性分析显示,NPPV可以改善预后[25]。因此,合并有免疫功能低下的ALI/ARDS病人早期可首先试用NPPV。

一般认为,ALI/ARDS病人在以下情况时不适宜应用NPPV[26,27]:①神志不清;②血流动力学不稳定;③气道分泌物明显增加而且气道自洁能力不足;④因脸部畸形、创伤或手术等不能佩戴鼻面罩;⑤上消化道出血、剧烈呕吐、肠梗阻和食道及上腹部手术等;⑥危及生命的低氧血症。应用NPPV治疗ALI/ARDS病人时应严密监测生命体征及治疗反应。如NPPV治疗1~2h后,低氧血症和全身情况得到改善,可继续应用NPPV。若低氧血症不能改善或全身情况恶化,提示NPPV治疗失败,应及时改为有创通气。

推荐意见3:预计病情能够短期缓解的早期ALI/ARDS病人可考虑应用NPPV (推荐级别:C级)

推荐意见4: 合并有免疫功能低下的ALI/ARDS病人早期可首先试用NPPV (推荐级别:C级)

推荐意见5:应用NPPV治疗ALI/ARDS应严密监测病人的生命体征及治疗反应。神志不清、休克、气道自洁能力障碍的ALI/ARDS病人不宜应用NPPV(推荐级别:C级)

3.有创机械通气

(1)机械通气的时机选择

ARDS病人经高浓度吸氧仍不能改善低氧血症时,应气管插管进行有创机械通气。ARDS病人呼吸功明显增加,表现为严重的呼吸困难,早期气管插管机械通气可降低呼吸功,改善呼吸困难[28]。虽然目前缺乏RCT研究评估早期气管插管对ARDS的治疗意义,

但一般认为,气管插管和有创机械通气能更有效的改善低氧血症,降低呼吸功,缓解呼吸窘迫,并能够更有效的改善全身缺氧,防止肺外器官功能损害。

推荐意见6:ARDS病人应积极进行机械通气治疗 (推荐级别:E级)

(2)肺保护性通气

由于ARDS病人大量肺泡塌陷,肺容积明显减少,常规或大潮气量通气易导致肺泡过度膨胀和气道平台压过高,加重肺及肺外器官的损伤。目前有5项多中心RCT研究比较了常规潮气量与小潮气量通气对ARDS病死率的影响[29~33]。其中Amato和ARDSnet的研究显示,与常规潮气量通气组比较,小潮气量通气组ARDS病人病死率显著降低,另外3项研究应用小潮气量通气并不降低病死率。进一步分析显示,阴性结果的3项研究中常规潮气量组和小潮气量组的潮气量差别较小,可能是导致阴性结果的主要原因之一

[34,35]。

气道平台压能够客观反映肺泡内压,过度升高可导致呼吸机相关肺损伤。在上述5项多中心RCT研究中,小潮气量组的气道平台压均<30 cmH2O,其中小潮气量降低病死率的2项研究中,对照组气道平台压>30 cmH2O,而不降低病死率的3项研究中,对照组的气道平台压均<30 cmH2O[30~32]。若按气道平台压分组(<23、23?27、27?33、>33cmH2O),随气道平台压升高,病死率显著升高(P=0.002)。若以气道平台压进行调整,不同潮气量通气组(5?6、7?8、9?10、11?12ml/kg)病死率无显著差异(P=0.18),而随气道平台压升高,病死率显著增加(P<0.001) [29~33]。说明在实施肺保护性通气策略时,限制气道平台压比限制潮气量更为重要。

由于ARDS肺容积明显减少,为限制气道平台压,有时不得不将潮气量降低,允许动脉血二氧化碳分压(PaCO2)高于正常,即所谓的允许性高碳酸血症。允许性高碳酸血症是肺保护性通气策略的结果,并非ARDS的治疗目标。急性二氧化碳升高导致酸血症可能产生一系列病理生理学改变,包括脑及外周血管扩张、心率加快、血压升高和心输出量增加等。但研究证实,实施肺保护性通气策略时一定程度的高碳酸血症是安全的[36]。当然,颅内压增高是应用允许性高碳酸血症的禁忌症。酸血症往往限制了允许性高碳酸血症的应用,目前尚无明确的二氧化碳分压上限值,一般主张保持pH>7.20~7.25,否则可考虑静脉输注碳酸氢钠[33]。

推荐意见7: 对ARDS病人实施机械通气时应采用肺保护性通气策略,气道平台压不应超过30~35cmH2O (推荐级别:B级)

(3)肺复张

充分复张ARDS塌陷肺泡是纠正低氧血症和保证PEEP效应的重要手段。为限制气道平台压而被迫采取的小潮气量通气往往不利于ARDS塌陷肺泡的膨胀,而PEEP维持肺复张的效应依赖于吸气期肺泡的膨胀程度。目前临床常用的肺复张手法包括控制性肺膨胀、PEEP递增法及压力控制法(PCV法) [37]。其中实施控制性肺膨胀采用恒压通气方式,

ARDS指南-10[1].10统稿-END 95_ards

推荐吸气压力30?45cmH2O、持续时间30?40s。临床研究证实肺复张手法能有效的促进塌陷肺泡复张,改善氧合,降低肺内分流。一项RCT研究显示,与常规潮气量通气比较,采用肺复张手法合并小潮气量通气,可明显改善ARDS病人的预后[29]。然而,ARDSnet对肺复张手法的研究显示,肺复张手法并不能改善氧合,试验也因此而中断[33]。有学者认为,得到阴性结果可能与复张压力不够有关。

肺复张手法的效应受多种因素影响。实施肺复张手法的压力和时间设定对肺复张的效应有明显的影响,不同肺复张手法效应也不尽相同。另外,ARDS病因不同,对肺复张手法的反应也不同,一般认为,肺外源性的ARDS对肺复张手法的反应优于肺内源性的ARDS;ARDS病程也影响肺复张手法的效应,早期ARDS肺复张效果较好。

值得注意的是,肺复张手法可能影响病人的循环状态,实施过程中应密切监测。

推荐意见8: 可采取肺复张手法促进ARDS病人塌陷肺泡复张,改善氧合 (推荐级别:D级)

(4)PEEP的选择

ARDS广泛肺泡塌陷不但可导致顽固的低氧血症,而且部分可复张的肺泡周期性开放而产生剪切力,导致或加重呼吸机相关肺损伤。充分复张塌陷肺泡后应用适当水平PEEP防止呼气末肺泡塌陷,改善低氧血症,并避免剪切力,防治呼吸机相关肺损伤。因此, ARDS应采用能防止肺泡塌陷的最低PEEP。

ARDS最佳PEEP的选择目前仍存在争议。Barbas通过荟萃分析比较了不同PEEP对ARDS病人生存率的影响,结果表明PEEP>12cmH2O、尤其是>16cmH2O明显改善生存率[38]。有学者建议可参照肺静态压力-容积(P-V)曲线低位转折点压力来选择PEEP。Amato及Villar的研究显示,在小潮气量通气的同时,以静态P-V曲线低位转折点压力+2cmH2O作为PEEP,结果与常规通气相比ARDS病人的病死率明显降低[29,39]。若有条件,应根据静态P-V曲线低位转折点压力+2cmH2O来确定PEEP。

推荐意见9:应使用能防止ARDS病人肺泡塌陷的最低PEEP,有条件情况下,应根据静态P-V曲线低位转折点压力+2cmH2O来确定PEEP (推荐级别:B级)

(5)自主呼吸

自主呼吸过程中膈肌主动收缩可增加ARDS病人肺重力依赖区的通气,改善通气血流比例失调,改善氧合。一项前瞻对照研究显示,与控制通气相比,保留自主呼吸的病人镇静剂使用量、机械通气时间和ICU住院时间均明显减少[40]。因此,在循环功能稳定,人机协调性较好的情况下,ARDS病人机械通气时有必要保留自主呼吸。

推荐意见10:ARDS病人机械通气时应尽量保留自主呼吸 (推荐级别:C级)

(6)半卧位

ARDS病人合并VAP往往使肺损伤进一步恶化,预防VAP具有重要的临床意义。机械通气病人平卧位易发生VAP。研究表明,由于气管插管或气管切开导致声门的关闭功能丧失,机械通气病人胃肠内容物易于返流误吸进入下呼吸道,导致VAP。低于30度角的平卧位是院内获得性肺炎的独立危险因素。前瞻性RCT研究显示,机械通气病人平卧位和半卧位(头部抬高45度以上)VAP的患病率分别为34%和8%(P=0.003),经微生物培养确诊的VAP患病率分别为23%和5%(P=0.018), [41]。可见,半卧位显著降低机械通气病人VAP的发生。因此,除非有脊髓损伤等体位改变的禁忌症,机械通气病人均应保持半卧位,预防VAP的发生[42]。

推荐意见11:若无禁忌症,机械通气的ARDS病人应采用30~45度半卧位 (推荐级别:B级)

(7)俯卧位通气

俯卧位通气通过降低胸腔内压力梯度、促进分泌物引流和促进肺内液体移动,明显改善氧合[43]。一项随机研究采用每天7h俯卧位通气,连续7d,结果表明俯卧位通气明显改善ARDS病人氧合,但对病死率无明显影响。然而,若依据PaO2/FiO2对病人进行分层分析结果显示,PaO2/FiO2<88mmHg的病人俯卧位通气后病死率明显降低。此外,依据简化急性生理评分(SAPS) II进行分层分析显示,SAPS II高于49分的病人采用俯卧位通气后病死率显著降低[44]。最近,另外一项每天20h俯卧位通气的RCT研究显示,俯卧位通气有降低严重低氧血症病人病死率的趋势[45]。可见,对于常规机械通气治疗无效的重度ARDS病人,可考虑采用俯卧位通气。

严重的低血压、室性心律失常、颜面部创伤及未处理的不稳定性骨折为俯卧位通气的相对禁忌症。当然,体位改变过程中可能发生如气管插管及中心静脉导管意外脱落等并发症,需要予以预防,但严重并发症并不常见[46]。

推荐意见12:常规机械通气治疗无效的重度ARDS病人,若无禁忌症,可考虑采用俯卧位通气 (推荐级别:C级)

(8)镇静镇痛与肌松

机械通气病人应考虑使用镇静镇痛剂,以缓解焦虑、躁动、疼痛,减少过度的氧耗。合适的镇静状态、适当的镇痛是保证病人安全和舒适的基本环节。

机械通气时应用镇静剂应先制定镇静方案,包括镇静目标和评估镇静效果的标准,根据镇静目标水平来调整镇静剂的剂量。临床研究中常用Ramsay评分来评估镇静深度、制定镇静计划,以Ramsay评分3~4分作为镇静目标[47]。每天均需中断或减少镇静药物剂量直到病人清醒,以判断病人的镇静程度和意识状态。RCT研究显示,与持续镇静相比,每天间断镇静病人的机械通气时间、ICU住院时间和总住院时间均明显缩短,气管切开率、镇静剂的用量及医疗费用均有所下降[47~49]。可见,机械通气的ARDS病人应用镇静剂是应先制定镇静方案,并实施每日唤醒。

危重病人应用肌松药后,可能延长机械通气时间、导致肺泡塌陷和增加VAP发生率,并可能延长住院时间。机械通气的ARDS病人应尽量避免使用肌松药物。如确有必要使用肌松药物,应监测肌松水平以指导用药剂量,以预防膈肌功能不全和VAP的发生[50]。

推荐意见13:应对机械通气的ARDS病人制定镇静方案(镇静目标和评估) (推荐级别:B级)

推荐意见14:机械通气的ARDS病人不推荐常规使用肌松剂 (推荐级别:E级)

4.液体通气

部分液体通气是在常规机械通气的基础上经气管插管向肺内注入相当于功能残气量的全氟碳化合物,以降低肺泡表面张力,并促进肺重力依赖区塌陷肺泡复张。研究显示,部分液体通气72h后,ARDS病人肺顺应性可以得到改善,并且改善气体交换,对循环无明显影响。但病人预后均无明显改善,病死率仍高达50%左右[51,52]。近期对90例ALI/ARDS病人的RCT研究显示,与常规机械通气相比,部分液体通气既不缩短机械通气时间,也不降低病死率,进一步分析显示,对于年龄<55岁的患者,部分液体通气有降低机械通气时间的趋势[53]。部分液体通气能改善ALI/ARDS病人气体交换,增加肺顺应性,可作为严重ARDS病人常规机械通气无效时的一种选择。

5.体外膜氧合技术(ECMO)

建立体外循环后可减轻肺负担、有利于肺功能恢复。非对照临床研究提示,严重的ARDS病人应用ECMO后存活率46~66% [54,55]。但RCT研究显示,ECMO并不改善ARDS病人预后[56]。随着ECMO技术的改进,需要进一步的大规模研究结果来证实ECMO在ARDS治疗中的地位。

推荐意见15:常规治疗无效的ARDS病人,可考虑应用ECMO (推荐级别:D级)

(三)ALI/ARDS药物治疗

1.液体管理

高通透性肺水肿是ALI/ARDS的病理生理特征,肺水肿的程度与ALI/ARDS的预后呈正相关[57],因此,通过积极的液体管理,改善ALI/ARDS病人的肺水肿具有重要的临床意义。

研究显示液体负平衡与感染性休克病人病死率的降低显著相关[58],且对于创伤导致的ALI/ARDS病人,液体正平衡使病人病死率明显增加。应用利尿剂减轻肺水肿可能改善肺部病理情况,缩短机械通气时间,进而减少呼吸机相关肺炎等并发症的发生。但是利尿减轻肺水肿的过程可能会导致心输出量下降,器官灌注不足。因此,ALI/ARDS病人的液体管理必需考虑到二者的平衡,必需在保证脏器灌注前提下进行。

最近ARDSnet完成的不同ARDS液体管理策略的研究显示[59],尽管限制性液体管理与非限制性液体管理组病死率无明显差异,但与非限制性液体管理相比,限制性液体管理

(利尿和限制补液)组病人第一周的液体平衡为负平衡(-136ml vs +6992ml),氧合指数明显改善,肺损伤评分明显降低,而且ICU住院时间明显缩短。特别值得注意的是,限制性液体管理组的休克和低血压的发生率并无增加。可见,在维持循环稳定,保证器官灌注的前提下,限制性的液体管理策略对ALI/ARDS病人是有利的。

ARDS病人采用晶体还是胶体液进行液体复苏一直存在争论。最近的大规模RCT研究显示,应用白蛋白进行液体复苏,在改善生存率、脏器功能保护、机械通气时间及ICU住院时间等方面与生理盐水无明显差异[60]。但值得注意的是,胶体渗透压是决定毛细血管渗出和肺水肿严重程度的重要因素。研究证实,低蛋白血症是严重感染病人发生ARDS的独立危险因素,而且低蛋白血症可导致ARDS病情进一步恶化,并使机械通气时间延长,病死率也明显增加[61]。因此,对低蛋白血症的ARDS病人,有必要输入白蛋白或人工胶体,提高胶体渗透压。最近两个多中心RCT研究显示,对于存在低蛋白血症(血浆总蛋白<5-6g/dl)的ARDS病人,与单纯应用速尿相比,尽管白蛋白联合速尿治疗未能明显降低病死率,但可明显改善氧合、增加液体负平衡,并缩短休克时间[62,63]。因此,对于低蛋白血症的ARDS病人,补充白蛋白等胶体溶液的同时联合应用速尿,有助于实现液体负平衡,并改善氧合。

推荐意见16:在保证组织器官灌注前提下,应实施限制性的液体管理,有助于改善ALI/ARDS病人的氧合和肺损伤 (推荐级别:B级)

2.糖皮质激素

全身和局部的炎症反应是ALI/ARDS发生和发展的重要机制,研究显示血浆和肺泡灌洗液中的炎症因子浓度升高与ARDS病死率成正相关[64]。长期以来,大量的研究试图应用糖皮质激素控制炎症反应,预防和治疗ARDS。早期的三项多中心RCT研究观察了大剂量糖皮质激素对ARDS的预防和早期治疗作用,结果糖皮质激素既不能预防ARDS的发生,对早期ARDS也没有治疗作用 [65~67]。但对于过敏原因导致的ARDS病人,早期应用糖皮质激素经验性治疗可能有效。此外感染性休克并发ARDS的病人,如合并有肾上腺皮质功能不全,可考虑应用替代剂量的糖皮质激素[68]。

持续的过度炎症反应和肺纤维化是导致ARDS晚期病情恶化和治疗困难的重要原因。糖皮质激素能抑制ARDS晚期持续存在的炎症反应,并能防止过度的胶原沉积[64],从而有可能对晚期ARDS有保护作用。小样本RCT试验显示,对于治疗一周后未好转的ARDS病人,糖皮质激素治疗组的病死率明显低于对照组,感染发生率与对照组无差异,高血糖发生率低于对照组[69]。然而,最近ARDSnet的研究观察了糖皮质激素对晚期ARDS(患病7-24d)的治疗效应[70],结果显示糖皮质激素治疗(甲基强的松龙 2mg/kg.d,分四次iv,14d后减量)并不降低60d病死率,但明显改善的低氧血症和肺顺应性,缩短病人的休克持续时间和机械通气时间。进一步亚组分析显示,ARDS发病>14d应用糖皮质激素明显增加病死率。可见,对于晚期ARDS患者不宜常规应用糖皮质激素治疗。

推荐意见17:不推荐应用糖皮质激素预防ARDS,也不推荐常规应用糖皮质激素治

疗ARDS (推荐级别:B级)

3.一氧化氮(NO)吸入

NO吸入可选择性扩张肺血管,而且NO分布于肺内通气良好的区域,扩张该区域的肺血管,显著降低肺动脉压,减少肺内分流,改善通气血流比例失调,并且可减少肺水肿形成[71]。临床研究显示,NO吸入可使约60%的ARDS病人氧合改善,同时肺动脉压、肺内分流明显下降,但对平均动脉压和心输出量无明显影响。但是氧合改善效果也仅限于开始NO吸入治疗的24-48h内[71,72]。两个RCT研究证实NO吸入并不能改善ARDS病人的病死率[72,73]。因此,吸入NO不宜作为ARDS病人的常规治疗手段,仅在一般治疗无效的严重低氧血症时可考虑应用。

推荐意见18:不推荐吸入NO作为ARDS病人常规治疗 (推荐级别:A级)

4.肺泡表面活性物质

ARDS病人存在肺泡表面活性物质减少或功能丧失,易引起肺泡塌陷。肺泡表面活性物质能降低肺泡表面张力,减轻肺炎症反应,阻止氧自由基对细胞膜的氧化损伤[74]。因此,补充肺泡表面活性物质可能成为ARDS的治疗手段。但是,RCT研究显示,应用表面活性物质后,ARDS病人的血流动力学指标、动脉氧合、机械通气时间、ICU住院时间和30d生存率并无明显改善[75]。有学者认为阴性结果可能与表面活性物质剂量不足有关。随后的小样本剂量对照性研究显示,与安慰剂组及肺泡表面活性物质50mg/kg应用4次比较,100mg/kg应用4次和8次,有降低ARDS 28d病死率的趋势(43.8%、50% vs 18.8%、16.6%,P=0.075) [76]。目前肺泡表面活性物质的应用仍存在许多尚未解决的问题,如最佳用药剂量、具体给药时间、给药间隔和药物来源等。因此,还不能将其作为ARDS的常规治疗手段。

推荐意见19:不推荐肺泡表面活性物质作为ARDS的常规治疗 (推荐级别:B级)

5.前列腺素E1

前列腺素E1(PGE1)不仅是血管活性药物,还具有免疫调节作用,可抑制巨噬细胞和中性粒细胞的活性,发挥抗炎作用。但是PGE1没有组织特异性,静脉注射PGE1会引起全身血管舒张,导致低血压。静脉注射PGE1用于治疗ALI/ARDS,目前已经完成了多个RCT研究,但无论是持续静脉注射PGE1[77],还是间断静脉注射脂质体PGE1[78~80],与安慰剂组相比,PGE1组在28d病死率,机械通气时间和氧合等方面并无益处。有研究报道吸入型PGE1可以改善氧合,但这需要进一步RCT研究证实[81]。因此,只有在ALI/ARDS病人低氧血症难以纠正时,可以考虑吸入PGE1治疗。

6.N-乙酰半胱氨酸和丙半胱氨酸

抗氧化剂N-乙酰半胱氨酸(NAC)和丙半胱氨酸(Procysteine)通过提供合成谷胱甘肽

ARDS指南-10[1].10统稿-END 95_ards

(GSH)的前体物质半胱氨酸,提高细胞内GSH水平,依靠GSH氧化还原反应来清除体内氧自由基,从而减轻肺损伤。静脉注射NAC对ALI病人可以显著改善全身氧合和缩短机械通气时间[82]。而近期在ARDS病人中进行的Ⅱ期临床试验证实,NAC有缩短肺损伤病程和阻止肺外器官衰竭的趋势,不能减少机械通气时间和降低病死率[83,84]。丙半胱氨酸的Ⅱ、Ⅲ期临床试验也证实不能改善ARDS病人预后[8]。因此,尚无足够证据支持NAC等抗氧化剂用于治疗ARDS。

7.环氧化酶抑制剂

布洛芬等环氧化酶抑制剂,可抑制ALI/ARDS病人血栓素A2的合成,对炎症反应有强烈抑制作用。小规模临床研究发现布洛芬可改善全身感染病人氧合与呼吸力学[85]。严重感染的临床研究也发现布洛芬可以降低体温、减慢心率和减轻酸中毒,但是,亚组分析(ARDS病人130例)显示,布洛芬既不能降低危重病人ARDS的患病率,也不能改善ARDS病人30d生存率[86]。因此,布洛芬等环氧化酶抑制剂尚不能用于ALI/ARDS病人常规治疗。

8.细胞因子单克隆抗体或拮抗剂

炎症性细胞因子在ALI/ARDS发病中具有重要作用。动物实验应用单克隆抗体或拮抗剂中和肿瘤坏死因子(TNF)、白细胞介素(IL)-1和IL-8等细胞因子可明显减轻肺损伤,但多数临床试验获得阴性结果。近期结束的两项大样本临床试验,观察抗TNF单克隆抗体(Afelimomab)治疗严重感染的临床疗效,尤其是对于IL-6水平升高病人的疗效,但结果也不一致[87,88]。其中MONARCS研究(n=2634)显示,无论在IL-6高水平还是低水平的严重感染病人,Afelimomab治疗组的病死率明显降低[88]。但另一项研究并不降低病死率。细胞因子单克隆抗体或拮抗剂是否能够用于ALI/ARDS的治疗,目前尚缺乏临床研究证据。因此,不推荐抗细胞因子单克隆抗体或拮抗剂用于ARDS治疗。

9.己酮可可碱及其衍化物利索茶碱

己酮可可碱(Pentoxifylline)及其衍化物利索茶碱(Lisofylline)均可抑制中性粒细胞的趋化和激活,减少促炎因子TNFα、IL-1和IL-6等释放,利索茶碱还可抑制氧自由基释放。但目前尚无RCT试验证实己酮可可碱对ALI/ARDS病人的疗效。一项大样本的Ⅲ期临床试验(n=235)显示,与安慰剂组相比,应用利索茶碱治疗ARDS,28d病死率并无差异(利索茶碱31.9%,安慰剂24.7%, P=0.215),另外,28d内无需机械通气时间、无器官衰竭时间和院内感染发生率等亦无差异[89]。因此,己酮可可碱或利索茶碱不推荐用于ARDS治疗。

10.重组人活化蛋白C

重组人活化蛋白C(rhAPC或称Drotrecogin alfa)具有抗血栓、抗炎和纤溶特性,已被试用于治疗严重感染。Ⅲ期临床试验证实,持续静脉注射rhAPC 24 μg/kg. h×96 h可以显著改善重度严重感染病人(APACHEⅡ>25)的预后[90]。基于ARDS的本质是全身性炎

症反应,且凝血性功能障碍在ARDS发生中具有重要地位,rhAPC有可能成为ARDS的治疗手段。但rhAPC治疗ARDS的Ⅱ期临床试验正在进行。因此,尚无证据表明rhAPC可用于ARDS治疗,当然,在严重感染导致的重度ARDS病人,如果没有禁忌症,可考虑应用rhAPC。rhAPC高昂的治疗费用也限制了它的临床应用。

11.酮康唑

酮康唑是一种抗真菌药,但可抑制白三烯和血栓素A2合成,同时还可抑制肺泡巨噬细胞释放促炎因子,有可能用于ARDS治疗。但是由 ARDSnet完成的大样本(n=234)临床试验显示,酮康唑既不能降低ARDS病人的病死率,也不能缩短机械通气时间[91]。在外科ICU病人中预防性口服酮康唑,治疗组的ARDS患病率明显降低,提示在高危病人中预防性应用酮康唑可能有效,但仍需要进一步临床试验证实[92]。因此,目前仍没有证据支持酮康唑可用于ARDS常规治疗,同时为避免抗耐药,对于酮康唑的预防性应用也应慎重。

12.鱼油

鱼油富含ω-3脂肪酸,如二十二碳六烯酸(DHA)、二十碳五烯酸(EPA)等,也具有免疫调节作用,可抑制二十烷花生酸样促炎因子释放,并促进PGE1生成。研究显示,通过肠道给ARDS病人补充EPA、γ-亚油酸和抗氧化剂, 可使病人肺泡灌洗液内中性粒细胞减少,IL-8释放受到抑制,病死率降低[93]。对机械通气的ALI病人的研究也显示,肠内补充EPA和γ-亚油酸可以显著改善氧合和肺顺应性,明显缩短机械通气时间,但对生存率没有影响[94]。新近的一项针对严重感染和感染性休克的临床研究显示,通过肠内营养补充EPA、γ-亚油酸和抗氧化剂,明显改善氧合,并可缩短机械通气时间与ICU住院时间,减少新发的器官功能衰竭,降低了28d病死率[95]。此外,肠外补充EPA和γ-亚油酸也可减少严重感染病人ICU住院时间,并有降低病死率的趋势[96]。因此,对于ALI/ARDS病人,特别是严重感染导致的ARDS,可补充EPA和γ-亚油酸,以改善氧合,缩短机械通气时间。

推荐意见20:可通过肠内或静脉途径给予ALI/ARDS病人补充EPA和γ-亚油酸以改善氧合,缩短机械通气时间 (推荐级别:C级)

(四)ALI/ARDS的肾脏替代治疗

合并急性肾功能衰竭的ARDS病人可采用持续的静脉-静脉血液率过或间断血液透析治疗。ARDS病人循环中有大量炎症介质,肾脏替代治疗有可能部分清除这些炎症介质。研究显示,在严重烧伤伴有感染病人肾脏替代治疗6~8h后,上述炎症介质血浆水平较对照组明显下降[97]。另外,肾脏替代治疗有助于合并急性肾功能不全的ARDS病人的液体管理。研究显示,对于严重感染合并急性肾功能衰竭病人,持续血液滤过与间断血液透析组生存率没有显著性差异,但对血流动力学不稳定病人,持续肾脏替代治疗可能更有利

[98]。对于肾功能正常的ARDS者是否应用肾脏替代治疗,以及应用肾脏替代治疗是否改

善预后仍存在争议,肾脏功能正常的ARDS病人不宜常规应用肾脏替代治疗。

中华医学会重症医学分会《急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)》编写工作小组成员(按姓氏笔画排序):

参考文献

1. Dellinger RP, Carlet JM, Masur H, et al. Surviving Sepsis Campaign guidelines

for management of severe sepsis and septic shock. Intensive Care Med, 2004,30: 536-555.

2. Bernard GR,Artigas A, Brigham KL, et al. The American-European Consensus

Conference on ARDS, definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med, 1994, 149: 818-824.

3. Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute

lung injury. N Engl J Med, 2005, 353 : 1685-1693.

4. Lewandowski K, Lewandowski M. Epidemiology of ARDS. Minerva Anestesiol,

2006, 72: 473-477.

5. Hughes M, Mackirdy FN, Ross J, et al. Acute respiratory distress syndrome: an

audit of incidence and outcome in Scottish intensive care units. Anaesthesia, 2003, 58: 838-845.

6. Bersten AD, Edibam C, Hunt T, et al. Incidence and mortality of acute lung

injury and acute respiratory distress syndrome in three Australia states. Am J Respir Crit Care Med, 2002, 165: 443-448.

7. Hudson LD, Milberg JA, Anardi D, et al. Clinical risks for development of the

acute respiratory distress syndrome. Am J Respir Crit Care Med, 1995, 151: 293-301.

8. Iribarren C, Jacobs DR, Sidney S, et al. Cigarette smoking, alcohol consumption,

and risk of ARDS: a 15-year cohort study in a managed care setting. Chest, 2000, 117: 163-168.

9. Kafft P, Fridrich P, Pernerstorfer T, et al. The acute respiratory distress

syndrome: definitions, severity and clinical outcome, an analysis of 101 clinical investigations. Intensive Care Med, 1996, 22: 519-529.

10. Lu Y, Song Z, Zhou X, et al. A 12-month clinical survey of incidence and outcome

of acute respiratory distress syndrome in Shanghai intensive care units. Intensive Care Med, 2004, 30: 2197-2003.

11. Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med,

2000, 342: 1334-1349.

12. Idell S, Peters J, James KK, et al. Local abnormalities of coagulation and

fibrinolytic pathways that promote alveolar fibrin deposition in the lungs of

13. baboons with diffuse alveolar damage. J Clin Invest, 1989, 84: 181-193. Esteban A, Fernandez-Segoviano P, Frutos-Vivar F, et al. Comparison of clinical

criteria for the acute respiratory distress syndrome with autopsy findings. Ann Intern Med, 2004, 141: 440-445.

Tomashefski JF Jr. Pulmonary pathology of acute respiratory distress syndrome. Clin Chest Med, 2000, 21: 435-466.

Moloney ED, Evans TW. Pathophysiology and pharmacological treatment of pulmonary hypertension in acute respiratory distress syndrome. Eur Respiratory J, 2003, 21: 720-727.

Baudouin SV. Manipulation of inflammation in ARDS: achievable goal or distant 14. 15. 16.

target? Thorax, 2006, 61: 464-465.

17. Delluc A, L’Her E. Acute respiratory distress. Rev Part, 2006, 56: 737-745.

18. Cardenas VJ Jr, Lynch JE. Mechanical ventilation and acute respiratory distress

syndrome. Semin Thorac Cardiovasc Surg, 2006, 18: 8-12.

19. Keenan SP, Sinuff T, Cook DJ, et al. Does non-invasive positive pressure

ventilation improve outcome in acute hypoxemic respiratory failure? A systemic review. Crit Care Med, 2004, 32: 2516-2523.

20. Rana S, Jenad H, Gay PC, et al. Failure of non-invasive ventilation in patients

with acute lung injury: observational cohort Study. Critical Care 2006, 10: R79.

21. Delclaux C, L’Her E, Alberti C, et al. Treatment of acute hypoxemic

nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: A randomized controlled trial. JAMA, 2000, 284: 2352–2360.

22. Sevransky JE, Levy MM, Marini JJ. Mechanical ventilation in sepsis-induced

acute lung injury/acute respiratory distress syndrome: an evidence-based review. Crit Care Med, 2004, 32: S548-553.

23. Antonelli M, Conti G, Bufi M, et al. Noninvasive ventilation for treatment of

acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA, 2000, 283: 235-241.

24. Hilbert G, Gruson D, Vargas F, et al. Noninvasive ventilation in

immunosuppressed patients with pulmonary infiltrates, fever and acute respiratory failure. N Eng J Med, 2001, 344: 481-487.

25. Azoulay E, Alberti C, Bornstain C, et al. Improved survival in cancer patients

requiring mechanical ventilatory support: Impact of noninvasive mechanical ventilatory support. Crit Care Med, 2001, 29: 519-525.

26. Mehta S, Hill NS. Noninvasive Ventilation. Am J Respir Crit Care Med, 2001, 163:

540-577.

27. Brochard L, Mancebo J, Elliott MW. Noninvasive ventilation for acute

respiratory failure. Eur Respir J, 2002, 19: 712-721.

28. Marini JJ, Lamb VJ. External work output and force generation during

synchronized intermittent mechanical ventilation: Effect of machine assistance on breathing effort. Am Rev Respir Dis, 1988, 138: 1169-1179.

29. Amato MB, Barbas CS, Medeiros DM, et al. Effect of protective-ventilation

strategy on mortality in the acute respiratory distress syndrome. N Engl J Med, 1998, 338: 347-354.

30. Stewart TE, Meade MO, Cook DJ, et al. Evaluation of a ventilation strategy to

prevent barotraumas in patients at high risk for acute respiratory distress syndrome. Pressure- and volume-limited ventilation strategy group. N Engl J Med, 1998, 338: 355-361.

31. Brochard L, Roudat-Thoraval F, Roupie E, et al. Tidal volume reduction for

prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The multicenter trial group on tidal volume reduction in ARDS. Am J Respir Crit Care Med, 1998, 158: 1831-1838.

32. Brower RG, Shanholtz CB, Fessler HE, et al. Prospective randomized, controlled

clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med, 1999, 27: 1492-1498.

33. The acute respiratory distress syndrome network: Ventilation with lower tidal

volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000, 342: 1301-1308.

Brower RG, Fessler HE. Mechanical ventilation in acute lung injury and acute respiratory distress syndrome. Clin Chest Med, 2000, 21: 491-510.

Eichacker PQ, Gerstenberger EP, Banks SM, et al. Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am J Respir Crit Care Med, 2002, 166: 1510-1514.

Bidana A, Cardenas VJ, Zwischenberger JB. Permissive hypercapnia in acute respiratory failure. JAMA, 1994, 272: 957-962.

Lim SC, Adama AB, Simonson DA, et al. Intercomparison of recruitment 34. 35. 36. 37.

maneuver efficacy in three models of acute lung injury. Crit Care Med, 2004, 32: 2371-2377.

38. Barbaas CS, Dematos GF, Pincelli MP, et al. Mechanical ventilation in acute

respiratory failure: recruitment and high positive end-expiratory pressure are necessary. Curr Opin Crit Care, 2005, 11: 18-28.

39. Villar J, Kacmarek RM, Perez-Mendez L, et al. A high positive end-expiratory

pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care

ARDS指南-10[1].10统稿-END 95_ards

Med, 2006, 34: 1311-1318.

40. Putensen C, Mutz NJ, Putensen-Himmer G, et al. Spontaneous breathing during

ventilatory support improves ventilation-perfusion distributions in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med, 1999, 159: 1241–1248.

41. Drakulovic M, Torres A, Bauer TT, et al. Supine body position as a risk factor for

nosocomial pneumonia in mechanically ventilated patients: a randomized trial. Lancet, 1999, 354: 1851-1858.

42. American Thoracic Society and the Infectious Diseases Society of American.

Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388–416.

43. Lamm WJ, Graham MM, Albert RK. Mechanism by which the prone position

improves oxygenation in acute lung injury. Am J Respir Crit Care Med, 1994, 150: 184-193.

44. Gattinoni L, Tognoni G, Pesenti A, et al. Effect of prone positioning on the

survival of patients with acute respiratory failure. N Engl J Med, 2001, 345: 568–573.

45. Mancebo J, Fernandez R, Gordo F, et al. Prone vs supine position in ARDS

patients: Results of a randomized multicenter trial. Am J Respir Crit Care Med, 2003, 167: A180.

46. Gainnier M, Michelet P, Thirion X, et al. Prone position and positive

end-expiratory pressure in acute respiratory distress syndrome. Crit Care Med, 2003, 31: 2719-2726.

47. Kress JP, Pohlman AS, O’Connor MF, et al. Daily interruption of sedative

infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000, 342: 1471–1477.

48. Kollef MH, Levy NT, Ahrens TS, et al. The use of continuous IV sedation is

associated with prolongation of mechanical ventilation. Chest, 1998, 114: 541–548.

49. Brook AD, Ahrens TS, Schaiff R, et al. Effect of a nursing-implemented sedation

protocol on the duration of mechanical ventilation. Crit Care Med, 1999, 27: 2609–2615.

50. Rudis MI, Sikora CA, Angus E, et al. A prospective, randomized, controlled

evaluation of peripheral nerve stimulation versus standard clinical dosing of neuromuscular blocking agents in critically ill patients. Crit Care Med, 1997, 25: 575–583.

51. Hirschl R, Pranikoff T, Wise C, et al. Initial experience with partial liquid

ventilation in adult patients with the acute respiratory distress syndrome. JAMA, 1996, 275: 383-389.

52. Hirschl R, Conrad S, Kaiser R, et al. Partial liquid ventilation in adult patients

with ARDS: A multicenter phaseⅠ-Ⅱ trial. Adult PLV study group. Ann Surg, 1998, 228: 692-700.

53. Hirschl DB, Croce M, Gore D, et al. Prospective, randomized, controlled pilots

study of partial liquid ventilation in adult acute respiratory distress syndrome. Am J Respir Crit Care Med, 2002, 165: 781-787.

54. Lewandowski K, Rossaint R, Pappert D, et al. High survival rate in 122 ARDS

patients managed according to a clinical algorithm including extracorporeal membrane oxygenation. Intensive Care Med, 1997, 23: 819–835.

55. Zwischenberger JB, Conrad SA, Alpard SK, et al. Percutaneous extracorporeal

arteriovenous CO2 removal for severe respiratory failure. Ann Thorac Surg, 1999, 68: 181–187.

56. Zapol WM, Snider MT, Hill JD, et al. Extracorporeal membrane oxygenation in

severe acute respiratory failure. A randomized prospective study. JAMA, 1979, 242: 2193–2196.

57. Sakka SG, Reinhart K, Meier-Hellmann A. Prognostic value of the indocyanine

green plasma disappearance rate in critically ill patients. Chest, 2002, 122: 2080-2086.

58. Alsous F, Khamiees M, DeGirolamo A, et al. Negative fluid balance predicts

survival in patients with septic shock: A retrospective pilot study. Chest, 2000, 117: 1749-1754.

59. The national heart, lung, and blood institute acute respiratory distress syndrome

(ARDS) clinical trials network. Comparison of two fluid- management strategies in acute lung injury. N Engl J Med, 2006, 354: 2564-2575.

60. The SAFE Study Investigators. A comparison of albumin and saline for fluid

resuscitation in the intensive care unit. N Engl J Med, 2004, 350: 2247-2256.

61. Mangialardi RJ, Martin GS, Bernard GR, et al. Hypoproteinemia predicts acute

respiratory distress syndrome development, weight gain, and death in patients with sepsis. Ibupron in sepsis study group. Crit Care Med, 2000, 28: 3137–3145.

62. Martin GS, Mangialardi RJ, Wheeler AP, et al. Albumin and furosemide therapy

in hypoproteinemic patients with acute lung injury. Crit Care Med, 2002, 30: 2175-2182.

63. Martin GS, Moss M, Wheeler AP, et al. A randomized, controlled trial of

furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med, 2005, 33: 1681-1687.

64. Meduri GU, Headley S, Kohler G, et al. Persistent elevation of inflammatory

cytokines predicts a poor outcome in ARDS. Plasma IL-1 beta and IL-6 levels are consistent and efficient predictors of outcome over time. Chest, 1995, 107: 1062–1073.

65. Luce JM, Montgomery AB, Marks JD, et al. Ineffectiveness of high-dose

methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock. Am Rev Respir Dis, 1988, 138: 62–68.

66. Bone RC, Fisher CJ, Clemmer TP, et al. Early methylprednisolone treatment for

septic syndrome and the adult respiratory distress syndrome. Chest, 1987, 92: 1032–1036.

67. Bernard GR, Luce JM, Sprung CL, et al. High-dose corticosteroids in patients

with the adult respiratory distress syndrome. N Engl J Med, 1987, 317: 1565–1570.

68. Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of

hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA, 2002, 288: 862–871.

69. Meduri GU, Headley AS, Golden E, et al. Effect of prolonged

methylprednisolone therapy in unresolving acute respiratory distress syndrome:

A randomized controlled trial. JAMA, 1998, 280: 159–165.

70. The National Heart, Lung, and Blood Institute Acute Respiratory Distress

Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med, 2006, 354: 1671-1684.

71. Rossaint R, Falke KJ, Lopez F, et al. Inhaled nitric oxide for the adult respiratory

distress syndrome. N Engl J Med, 1993, 328: 399–405.

72. Dellinger RP, Zimmerman JL, Taylor RW, et al. Effects of inhaled nitric oxide in

patients with acute respiratory distress syndrome: Results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group. Crit Care Med, 1998, 26: 15–23.

73. Lundin S, Mang H, Smithies M, et al. Inhalation of nitric oxide in acute lung

injury: Preliminary results of a European multicenter study. Intensive Care Med, 1997, 23: S2.

74. Suwabe A, Otake K, Yakuwa N, et al. Artificial surfactant (Surfactant TA)

modulates adherence and superoxide production of neutrophils. Am J Respir Crit Care Med, 1998, 158:1 890-1899.

75. Anzueto A, Baughman RP, Guntupalli KK, et al. Aerosolized surfactant in adults

with sepsis-induced acute respiratory distress syndrome. N Engl J Med, 1996, 334: 1417-1421.

76. Gregory TJ, Steinberg KP, Spragg R, et al. Bovine surfactant therapy for patients

with acute respiratory distress syndrome. Am J Respir Crit Care Med, 1997, 155: 1309-1315.

77. Bone RC, Slotman G, Maunder R, et al. Randomized double-blind, multi-center

study of prostaglandin El in patients with the adult respiratory distress syndrome. Chest, 1989, 96: 114-119.

78. Abraham E, Park YC, Covington P, et al. Liposomal prostaglandin E1 in acute

respiratory distress syndrome: a placebo-controlled, randomized, double-blind, multicenter clinical trial. Crit Care Med, 1996, 24: 10-15.

79. Abraham E, Baughman R, Fletcher E, et al. Liposomal prostaglandin E1 (TLC

C-53) in acute respiratory distress syndrome: a controlled, randomized, double-blind, multicenter clinical trial. TLC C-53 ARDS Study Group. Crit Care Med, 1999, 27: 1478-1485.

80. Vincent JL, Brase R, Santman F, et al. A multi-centre, double blind,

placebo-controlled study of liposomal prostaglandin E1 (TLC C-53) in patients with acute respiratory distress syndrome. Intensive Care Med, 2001, 27: 1578-1583.

81. Meyer J, Theilmeier G, Van Aken HV,et al. Inhaled prostaglandin E1 for

treatment of acute lung injury in severe multiple organ failure. Anesth Analg, 1998, 86: 753-758.

82. Suter PM, Domenighetti G, Schaller MD, et al. N-acetylcysteine enhances

recovery from acute lung injury in man. A randomized, double-blind, placebo-controlled clinical study. Chest, 1994, 105: 190-194.

83. Domenighetti G, Suter PM, Schaller MD, et al. Treatment with N-acetylcysteine

during acute respiratory distress syndrome: a randomized, double-blind, placebo-controlled clinical study. J Crit Care, 1997, 12: 177-182.

84. Bernard GR, Wheeler AP, Arons MM, et al. A trial of antioxidants

N-acetylcysteine and procysteine in ARDS. The Antioxidant in ARDS Study Group. Chest, 1997, 112: 164-172.

85. Bernard GR, Reines HD, Halushka PV, et al. Prostacyclin and thromboxane A2

formation is increased in human sepsis syndrome. Effects of cyclooxygenase inhibition. Am Rev Respir Dis, 1991, 144: 1095–1101.

86. Bernard GR, Wheeler AP, Russell JA, et al. The effects of ibuprofen on the

physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group. N Engl J Med, 1997, 336: 912–918.

87. Reinhart K, MengesT, Gardlund B, et al. Randomized, placebo-controlled trial of

the anti-tumor necrosis factor antibody fragment afelimomab in hyperinflammatory response during severe sepsis: The RAMSES Study. Crit Care Med, 2001, 29: 765-769.

88. Panacek EA , Marshall JC, Albertson TE, et al. Efficacy and safety of the

monoclonal anti-tumor necrosis factor antibody F(ab')2 fragment afelimomab in patients with severe sepsis and elevated interleukin-6 levels. Crit Care Med, 2004, 32: 2173-2182.

89. Randomized, placebo-controlled trial of lisofylline for early treatment of acute

lung injury and acute respiratory distress syndrome. Crit Care Med, 2002, 30: 1-6.

90. Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant

human activated protein C for severe sepsis. N Engl J Med, 2001, 344: 699-709.

91. Ketoconazole for early treatment of acute lung injury and acute respiratory

distress syndrome: a randomized controlled trial. The ARDS Network. JAMA, 2000, 283: 1995-2002.

92. Yu M, Tomasa G. A double-blind, prospective, randomized trial of ketoconazole,

a thromboxane synthetase inhibitor, in the prophylaxis of the adult respiratory distress syndrome. Crit Care Med, 1993, 21: 1635-1642.

93. Pacht ER, DeMichele SJ, Nelson JL, et al. Enteral nutrition with eicosapentaenoic

acid, gamma-linolenic acid, and antioxidants reduces alveolar inflammatory mediators and protein influx in patients with acute respiratory distress syndrome. Crit Care Med, 2003, 31: 491–500.

94. Singer P, Theilla M, Fisher H, et al. Benefit of an enteral diet enriched with

eicosapentaenoic acid and gamma-linolenic acid in ventilated patients with acute lung injury. Crit Care Med, 2006, 34: 1033–1038.

95. Pontes-Arruda A, Aragao AM, Albuquerque JD. Effects of enteral feeding with

eicosapentaenoic acid, linolenic acid, and antioxidants in mechanically ventilated patients with severe sepsis and septic shock. Crit Care Med, 2006, 34: 2325–2333.

96. Mayer K, Schaefer MB, Seeger W. Fish oil in the critically ill: from experimental

to clinical data. Curr Opin Clin Nutr Metab Care, 2006, 9: 140-148.

97. Yizhi P, Zhiqiang Y, Hongbin L. Removal of inflammatory cytokines and

endotoxin by veno-venous continuous renal replacement therapy for burned patients with sepsis. Burns, 2005, 31: 623–628.

98. Kellum J, Angus DC, Johnson JP, et al. Continuous versus intermittent renal

replacement therapy: a meta-analysis. Intensive Care Med, 2002, 28: 29-37.

ARDS指南-10[1].10统稿-END 95_ards

急性肺损伤/急性呼吸窘迫综合征诊断治疗指南(2006)(摘要)

中华医学会重症医学分会

推荐意见1:积极控制原发病是遏制ALI/ARDS发展的重要环节 (推荐级别:E级) 推荐意见2:常规氧疗是纠正ALI/ARDS病人低氧血症的基本手段 (推荐级别:E级)

推荐意见3:预计病情能够短期缓解的早期ALI/ARDS病人可考虑应用NPPV (推荐级别:C级)

推荐意见4: 合并有免疫功能低下的ALI/ARDS病人早期可首先试用NPPV (推荐级别:C级)

推荐意见5:应用NPPV治疗ALI/ARDS时,应严密监测病人的生命体征及治疗反应。神志不清、休克、气道自洁能力障碍的ALI/ARDS病人不宜应用NPPV(推荐级别:C级)推荐意见6:ARDS病人应积极进行机械通气治疗 (推荐级别:E级)

推荐意见7: 对ARDS病人实施机械通气时应采用肺保护性通气策略,气道平台压不应超过30~35cmH2O (推荐级别:B级)推荐意见8:可采取肺复张手法促进ARDS病人塌陷肺泡复张,改善氧合 (推荐级别:D级)

推荐意见9:应使用能防止ARDS病人肺泡塌陷的最低PEEP,有条件情况下,应根据静态P-V曲线低位转折点压力+2cmH2O来确定PEEP (推荐级别:B级) 推荐意见10:ARDS病人机械通气时应尽量保留自主呼吸 (推荐级别:C级) 推荐意见11:若无禁忌症,机械通气的ARDS病人应采用30~45度半卧位 (推荐级别:B级)

推荐意见12:常规机械通气治疗无效的重度ARDS病人,若无禁忌症,可考虑采用俯卧位通气 (推荐级别:C级)

推荐意见13:应对机械通气的ARDS病人制定镇静方案(镇静目标和评估) (推荐级别:B级)

推荐意见14:机械通气的ARDS病人不推荐常规使用肌松剂 (推荐级别:E级) 推荐意见15:常规治疗无效的ARDS病人,可考虑应用ECMO (推荐级别:D级) 推荐意见16:在保证组织器官灌注前提下,应实施限制性的液体管理,有助于改善ALI/ARDS病人的氧合和肺损伤 (推荐级别:B级)

推荐意见17:不推荐应用糖皮质激素预防ARDS,也不推荐常规应用糖皮质激素治疗ARDS (推荐级别:B级)

推荐意见18:不推荐吸入NO作为ARDS病人常规治疗 (推荐级别:A级) 推荐意见19:不推荐肺泡表面活性物质作为ARDS的常规治疗 (推荐级别:B级) 推荐意见20:可通过肠内或静脉途径给予ALI/ARDS病人补充EPA和γ-亚油酸以改善氧合,缩短机械通气时间 (推荐级别:C级)

NO.3 外链宝典:草根站长投稿指南

 

  百度百科取消扩展阅读、A5论坛取消签名功能,连日来各方势力不断打压垃圾外链,很多草根站长无奈地感叹:“能发外链的地方真是越来越少了。”不错,可以发外链的高权重论坛就那么几个,谁也不能保证它们不会跟随A5的步伐。但是“内容为王、外链为皇”一直是站长SEO的信条,各大论坛取消了签名,难道我们草根站长就不做外链了么?不,其实我们还有最后一根救命稻草,那就是投稿!

  一、草根站长为什么投稿

  1、草根站长在江湖上属于最弱势的群体,要人没人,要钱没钱,能掌握到的流量和外链都极不稳定。

  2、现在外链很难做。论坛外链会被搜索引擎视为没有效果的垃圾外链。

  3、A5已经取消论坛签名,签名外链的时代恐怕即将完结。

  4、对于搜索引擎来说,越难搞到的链接越有价值。

  5、向高权重网站投稿,不仅可以带来流量和知名度,最重要的是外链。你的文章一旦在站长之家类的门户网站发表,就会获得大量转载,与其辛辛苦苦批量生产垃圾外链,还不如让读者心甘情愿的为你制造更自然、更稳定、权重更高的外链。

  二、草根站长要向谁投稿

  在投稿之前,草根站长首先要选择好文章题材,因为每个网站的主题不一样,接受稿件的题材也会略有不同。文章可以投给知名博客,也可以投给门户网站,如果是站长类的文章,可以投给卢松松博客、站长之家、A5这些有影响力的站长媒体;如果是科技类文章,那就可以考虑投稿到月光博客了。

  总体来说就是文章要对口、网站要够牛,稿件发表之后能够产生你想要的效果。

  三、投稿一定要投其所好

  动笔之前,一定要调查清楚你的投稿目标网站喜欢什么样的文章。向他投稿,就要投其所好,这样才能提高文章的通过率。你可以研究下这个网站发表最多的是哪类文章,他接受投稿最多的是哪类文章,这个网站上最受读者欢迎的又是哪类文章。如果这三项资格同时具备,那就是你要写的文章题材。

  比如向卢松松博客投稿,我们知道卢松松的读者大部分都是草根站长,而且卢松松曾在博文《我的2012年年终总结》中提到:“后面才发现,从大处着眼,从小事做起。标题取的太大,容易迷失方向,经过几个月的观察,我发现你们还是喜欢站长、搜索引擎方面的文章。”这样我们就清楚了,卢松松和他的读者最喜欢的是站长和搜索引擎方面的内容,写他们喜闻乐见的东西,就更容易被审核通过。

  四、网站读者最喜欢什么

  投稿的目的是流量、知名度、外链。最重要的是外链。文章在高权重网站发布之后,只能获得一条高质量外链,要想获得更多链接,就要好好想一想,读者们最喜欢什么样的文章。也就是什么样的文章才能让读者产生共鸣,并且心甘情愿的转载你的文章。这些读者才是根本,才是投稿的真正目标。

  无限博客观察过,在站长之家这类门户网站上每天会发布很多投稿,但真正受欢迎的却如凤毛麟角,大部分文章都石沉大海,露一小脸儿就被淹没。这种文章大多距离普通站长很远或者毫无新意,虽然能在站长之家审核通过,但其实并没什么吸引力,读者不转载,那么投稿的效果就会大打折扣。

  五、投稿文章应该怎么写

  投稿就等于外链,听起来的确非常诱人,但有的站长却很苦恼,不擅长写作怎么办?毕竟不是每个人都擅长写作。

  个人见解,对于我们这种草根站长来说,很难写出有质量的科技文章,而且又拿不到第一手的行业资讯,那么最简单的方法就是写经验性的文章。不论成功经验还是失败经验都可以,这类文章最有可读性,也最容易引起读者共鸣,当然,前提是要写你的真实经历。经验性文章不需要华丽的文采,只需要用心写就可以。

  写文章不要急于求成,要保证质量。一周之内写好即可。中间可以反复修改,或者丰富内容。好文章需要沉淀。

  六、稿件发布之后怎么办

  稿件一旦发布,千万不要高兴的太早,接下来要做的工作有很多,这时候你才刚上路呢。首先,不要懒惰,为下一篇投稿做准备。并且考虑是否再把这篇文章投给其他网站,让稿件的影响力达到最大化。如果你的文章发表了,那就证明文章还不差。比如在卢松松博客发表之后,可以再投稿到站长之家。

  其次要注意,利用搜索引擎查看多少人转载了你的文章,然后提醒他们加上你的链接。除非是很垃圾的网站,一般人转载都会附带作者链接的。

  七、投稿者要有乐观心态

  投稿之前要做好被退稿的心理准备。如果真被退稿了,也不要灰心,很多时候被退稿的原因并不是文章质量不够,而可能是题材不适合目标网站的风格。比如说你写了站长类的文章可能会被月光博客退稿,但投稿到卢松松博客却能获得很棒的效果。所以上面才说搞清楚目标网站的胃口非常重要。

  如果同样题材的文章别人可以发表,你的却被退稿了,那真的就要从写作技巧上加把劲了。多写,多投,通常会有不错的效果。

  综上所述,向高权重网站投稿无疑是一条获得外链的捷径,但机会是留给有准备的人的,没有优秀的写作技巧和丰富的阅历,很难写出真正的好文章。所以草根站长要想在投稿之路上混出名堂,就要从现在做起,多看多读,认真写好每一篇文章。

  本文由无限博客原创,地址:

上一篇:辛夷坞我在回忆里等你|花生,花生!(寨里村记忆辛普森我之八) 上一篇:剑灵需要什么电脑配置|攒电脑需要什么买配置?
与该文相关的文章

温馨提示:如果您对51阅读吧有任何建议,请通过网站联系邮箱向我们反馈,感谢各位的建议与支持!