脓毒症心功能障碍相关机制的研究进展  

The research progress in the related mechanisms of sepsis-induced myocardial dysfunction

作　　者：陆胜 沈艳[1] 沈雁波[1] LU Sheng;SHEN Yan;SHEN Yanbo(Department of Emergency,the Affiliated Hospital of Nantong University,Nantong 226001)

机构地区：[1]南通大学附属医院急诊医学科,南通226001

出　　处：《南通大学学报（医学版）》2021年第2期152-157,共6页Journal of Nantong University(Medical sciences)

基　　金：国家卫生计生委医药科技发展研究中心医学科研专项课题(红日基金)。

摘　　要：心功能障碍是脓毒症引起的多器官衰竭的重要组成部分,且心脏往往是最早受累也是最常受累的器官,是引起脓毒症高死亡率的重要原因。目前对脓毒症引起的心功能障碍没有明确的定义,其临床表现为左心和(或)右心收缩和(或)舒张功能障碍。脓毒症心功能障碍的发病机制多且复杂,目前主要包括微循环障碍致心肌缺血缺氧、免疫反应及炎症介质对心肌细胞的损伤作用、线粒体结构功能障碍和心肌内钙水平下降影响心肌收缩等。在过去半个世纪中,脓毒症的诊治取得较多进展,死亡率较前有所降低。然而,由于脓毒症发病率的增加,每年死亡的人数仍居高不下,故需进一步研究脓毒症心功能障碍的发病机制以提高诊断敏感性和改善治疗策略,从而提高患者的生存率。本文旨在对导致脓毒症患者心功能障碍相关机制的研究进行综述。Cardiac dysfunction is an important component of multiple organ failure caused by sepsis.The heart is usually the earliest and most commonly involved organs,which leads to high mortality.There is currently no clear definition of sepsis-induced myocardial dysfunction.The main clinical manifestations are left and/or right heart(systolic and/or diastolic)dysfunction.The pathogenesis of septic heart dysfunction is complex,which mainly include myocardial ischemia,hypoxia caused by microcirculation disorders,damage of cardiomyocytes by the immune response,damage of inflammatory mediators to cardiocytes,mitochondrial structural dysfunction,and myocardial calcium levels affecting myocardial contraction,ect.In the last half-century,we have made remarkable progress in the diagnosis and treatment of sepsis,and the mortality rate has decreased.However,due to the increase of morbidity,the number of deaths per year remains high.Therefore,it is necessary to further study the pathogenesis of sepsis-induced myocardial dysfunction to improve diagnostic methods and treatment strategies,so as to improve the survival rate of patients.This article aims to review the current research on pathogenesis related to cardiac dysfunction in septic patients.

关 键 词：脓毒症心功能障碍 微循环 免疫反应 炎症介质 线粒体功能障碍 钙稳态 

分 类 号：R320.61[医药卫生—人体解剖和组织胚胎学]