脓毒性心肌功能障碍

Septic Myocardial Dysfunction

脓毒症是由感染引起的全身炎症反应综合征,证实有感染灶存在或有高度可疑的感染灶。脓毒症是ICU内重症患者的主要死亡原因,且发病率随着年龄的增长而逐渐增加。近十年来,虽然政府在救治脓毒症患者中投入了巨大的资金和技术支持,但源于脓毒症或脓毒性休克患者的病死率仍高达30%-60%。心血管系统在脓毒症与脓毒性休克的病理生理学中扮演着重要着色。过去的四五十年,开展了很多脓毒性心肌功能障碍方面的研究,也积累了不少循证医学证据。然而,心脏只是心血管系统的一部分。诸如脓毒症患者机体血流动力学的变化系脓毒症对心脏的直接效应,还是脓毒症引起心脏前、后负荷及神经体液因素的变化,继而引起心脏继发改变的研究,至今仍在继续。本文概述了近年来脓毒性心肌功能障碍的研究进展,使读者更全面地了解脓毒性心肌功能障碍的病理生理学改变,合理有效地指导脓毒症和脓毒性休克患者的临床救治。

Sepsis is systemic inflammatory response syndrome caused by the focus of infection or potentially suspicious focus of infection. Sepsis is a major cause of critical patients in the intensive care unit （ICU）, and its incidence is constantly increasing with the aging and growth of the population. Mortality rate from severe sepsis or septic shock still ranges from 30% to 60% over the last decades despite the aggressive treatment and the enormous costs invested by official government. The cardiovascular system plays a key role in the pathophysiology of sepsis and septic shock. The evidence for myocardial dysfunction in septic shock has been accumulated in numerous studies over the last 40 to 50 years. Nevertheless, because the heart is only one part of the cardiovascular system, the studies on the correlations between the change of hemodynamics and the direct effects of sepsis on the heart, or the changes in preload, afterload and neurohumoral activity are continuing up to now. The purpose of this article is to review the studies on septic myocardial dysfunction, and make readers better understand the viewpoints of its mechanism nowadays, and put these theories into clinical treatment on the patients with sepsis or septic shock effectively.