脓毒症急性肺损伤治疗的研究进展

Progress of research on treatment of sepsis-induced acute lung injury

脓毒症常继发于创伤、烧伤和感染、休克等情况,如果治疗不及时,将进一步发展为多器官衰竭而死亡。脓毒症可激活肺内大量巨噬细胞,释放大量炎症因子,引起急性肺损伤(ALI),作为脓毒症的严重并发症,急性呼吸窘迫综合征(ARDS)具有较高的发病率和病死率。ALI/ARDS患者由于肺泡上皮细胞和肺毛细血管内皮细胞的弥漫性损伤可以导致肺泡毛细血管通透性增加,导致肺水肿,临床表现为难治性低氧血症和致命性呼吸衰竭,目前尚无可靠的方法如生物学标志物等预测其发生、发展,临床以支持治疗为主。本文主要就脓毒症相关的肺损伤发病机制及其治疗的最新进展综述如下。

Sepsis often arises as a secondary condition following trauma,burns,infections,shock,and other conditions.Untimely intervention can lead to the progression of sepsis into multi-organ failure and eventual mortality.Sepsis triggers a significant activation of macrophages in the lungs,resulting in the release of a plethora of inflammatory factors that con-tribute to the development of acute lung injury(ALI).In severe cases,ALI can further advance to acute respiratory dis-tress syndrome(ARDS),which is a grave complication associated with sepsis and carries a high morbidity and mortality rate.ALI/ARDS induces diffuse damage to alveolar epithelial cells and pulmonary capillary endothelial cells,leading to an increase in alveolar capillary permeability and subsequent pulmonary edema.Clinical manifestations of ALI/ARDS include refractory hypoxemia and fatal respiratory failure.Currently,no reliable biomarkers or predictive methods are available for anticipating the occurrence and progression of ALI/ARDS,and supportive treatment is taken as the major clinical treat-ment approach.This review article aims to summarize the latest advancements in understanding the pathogenesis and ther-apeutic approaches for sepsis-associated lung injury.