心肺复苏相关肠道屏障损伤机制的研究进展

Research progress on the mechanism of gut barrier injury associated with cardiopulmonary resuscitation

心搏骤停是常见的心血管危重症,随着急救流程规范化,心肺复苏成功率逐年提高,但其远期生存率仍较低。以脏器缺血/再灌注损伤、全身炎症反应为主要特征的复苏后综合征是心肺复苏后患者死亡的首要原因。肠道是对缺血/再灌注损伤最敏感的器官之一,其局部免疫系统的紊乱、微生物组群及其代谢产物组的改变均加重肠黏膜缺血/再灌注损伤,破坏黏膜屏障,引起继发感染,进一步加重肠道及肠外重要组织器官损伤。心肺复苏后的肠道屏障功能损伤被认为是多脏器功能障碍综合征的始动因素,因此,如何及早预防、诊断与治疗心肺复苏后的肠道屏障损伤对提高复苏远期生存率至关重要。本文对心肺复苏相关肠道屏障损伤的可能机制进行论述,以期为心搏骤停患者的治疗提供参考价值。

Cardiac arrest(CA) is a common cardiovascular disease. With the standardization of emergency procedures, the success rate of cardiopulmonary resuscitation(CPR) has improved year by year, but the long-term survival rate is still low. Post-resuscitation syndrome, characterized by organ ischemia/reperfusion(I/R) injury and systemic inflammatory response, is the primary cause of death in post-resuscitation patients. The intestinal tract is one of the most sensitive organs to I/R injury. The disturbance of the local immune system and the change of microbiome and its metabolite group aggravate the I/R injury of the intestinal mucosa, destroy the mucosal barrier, cause secondary infection, and further aggravate the injury of intestine and extraintestinal important tissues and organs. The injury of intestinal barrier function after cardiopulmonary resuscitation is the initiating factor of multiple organ dysfunction syndromes. Therefore, the early prevention, the diagnosis and treatment of gut barrier injury after CPR are very important to improve the long-term survival rate of resuscitation. This article discusses the potential mechanisms of gut barrier injury after cardiopulmonary resuscitation to provide a reference value for treating patients with CA.