特布他林防治急性肺损伤后肺水肿的研究现状

Current status of research in terbutaline for the control of pulmonary edema after acute lung injury

急性肺损伤（acute lung inury,ALI）后渗透性肺水肿是导致损伤后呼吸功能衰竭的主要病理基础,其发生机制错综复杂,至今仍无完善的治疗方案.研究结果显示,β2-受体激动剂特布他林在一定程度上恢复或改善了肺微血管内皮、肺泡上皮的通透性,对肺泡Ⅱ型细胞的钠-钾-ATP酶和上皮细胞的肺泡侧钠通道活性均有上调作用,增强肺泡液体清除功能,对肺损伤后肺水肿具有良好的防治作用,是一种有前景的治疗措施.但是其临床效果尚需要进一步证实,而且其给药途径及药物用量有待进一步的临床实验研究.

Acute lung injury （ALI） and acute respiratory distress syndrome （ARDS） are associated with disruption of the alveolo-capillary barrier, which results in edema fluid accumulation and impaired gas exchange. Despite nearly 30 years of research,no specific pharmacological therapy has yet proven to be efficacious in manipulating the pathophysiological processes. Several in vitro and in vivo animal or human studies suggest a potential role for β2 agonists in the treatment of ALI/ARDS. Terbutaline has been shown to reduce pulmonary neutrophil sequestration and activation, decrease pulmonary microvascular permeability, accelerate alveolar fluid clearance, thus attenuating pulmonary edema and improving gas exchange. However, further work with large animals and patients is needed to confirm these findings and to determine the physiological benefits of the terbutaline effect and the doseresponse relationship.