心功能不全合并脓毒症的浅低温治疗现状

Current status of mild hypothermia therapy for cardiac dysfunction with sepsis

心功能不全合并脓毒症导致重症监护室(ICU)患者的病死率增高。目前,心功能不全合并脓毒症的临床治疗方法通常是延缓心力衰竭并联合抗脓毒症治疗。浅低温治疗将患者核心体温降至32~35℃,在心功能不全及脓毒症动物模型中能缓解症状、降低病死率。部分研究表明浅低温治疗心功能不全以及脓毒症可取得良好疗效,但因其有不良反应,目前是否能用于心功能不全合并脓毒症尚存争议。该文就浅低温的动物研究、浅低温在心功能不全及脓毒症的临床应用、温度对心脏及脓毒症的影响及可能机制,以及浅低温对其他脏器及凝血功能的影响等方面予以综述。

Cardiac dysfunction(CD)combined with sepsis leads to increase in mortality in intensive care unit(ICU).Currently,the clinical treatment of CD with sepsis is the combination of delaying heart failure and anti-sepsis therapeutics.Mild therapeutic hypothermia(MTH)may decrease the body temperature to 32-35℃,improve symptom and decrease mortality in patients with CD and animal with sepsis.MTH has been used in animal models of heart failure and sepsis with pronounced outcomes and reduced mortality.However,it remains controversial if MTH can be used in treating patients with CD and sepsis due to its side effects,although the effectiveness of MTH on CD and sepsis has been testified.The present article reviews the application of MTH on animal researches,clinical use for treatment of patients with CD and sepsis,the effect and possible mechanisms of temperature on heart and sepsis,as well as the effect of MTH onto other organs and coagulation function.