持续炎性反应-免疫抑制-分解代谢综合征治疗策略初探

Preliminary discussion of therapeutic strategies in persistent inflammation immunosuppression catabolismsyndrome

受医学和科研水平限制，目前仍然缺乏有效手段防治重症监护病房（ICU）中部分慢性危重症（CCI）患者出现的持续炎性反应一免疫抑制．分解代谢综合征（PICS）。由于PICS不受控制地持续进展，CCI患者的ICU住院时间和晚期死亡率大大增加，探索有效的治疗策略显然已迫在眉睫。针对PICS在老年脓毒症患者等特定人群中高发、病程进展后干预难度极大和多种重要病理变化合并出现的特点，其治疗的基本原则必须遵循：“重点筛查，早期防控，多手段联合干预”。而在具体干预措施方面，借鉴部分病理生理上具有相似性和关联性的免疫代谢紊乱疾病，并采取“合成代谢营养支持”是目前研究的热点，也是未来干预方案研究中潜力较大的突破口。本文总结了部分PICS的治疗策略，以期为PICS临床治疗策略发展奠定良好的基础。

So far, there is still lack of effective treatment to control persistent inflammation immunosuppression catabolism syndrome （PICS） appeared generally in those chronic critical illnesses （CCI） patients, restricted by the development of medicine and scientific research nowadays. Because the uncontrolled PICS aggravates continuously, ICUstay of the CCI patients has been obviously prolonging and the late mortality elevates greatly. So exploring effective therapeutic strategies is obviously pressing. With the characteristics in PICS such as that elderly with sepsis or severe trauma tops the list of morbidity, progressing illness is difficult to intervent and various pathology changes occur simultaneously, the fundamental principle of treatment, ＂Focal screening, early control, joint intervention＂ must be followed. As for the specific intervention, lessoning from some diseases with immune and metabolic disorders to take ＂anabolic nutrition support＂, is a research focus presently as well as a considerably potential breakthrough at the treatment research in the future. This review retrospects a series of therapeutic strategies of PICS, such as immunity, metabolism regulation, nutrition support, glucose control and physiotherapy, in the purpose of laying the foundation of the development of joint intervention strategy for PICS.