脓毒症心肌病的治疗研究进展  

Advances on the management strategies for sepsis-induced cardiomyopathy

作　　者：刘子惠 缪惠洁 张育才 Liu Zihui;Miao Huijie;Zhang Yucai(Department of Critical Care Medicine,Shanghai Children's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学医学院附属儿童医院重症医学科,200062

出　　处：《中国小儿急救医学》2024年第10期783-787,共5页Chinese Pediatric Emergency Medicine

基　　金：上海市科委“科技创新行动计划”医学创新研究专项-青年项目(23Y11900400)。

摘　　要：脓毒症心肌病(SIC)是脓毒症合并心脏功能障碍, 其定义、发病机制、诊断标准及治疗措施尚未形成统一的共识。SIC约占脓毒症患者的10%~70%, 诊断基于心功能测量和生物学标志物的测定, 核心指标是左心射血分数降低。现阶段认为SIC的治疗需要在感染治疗的基础上, 避免快速大剂量液体治疗;正性肌力药物使用需要兼顾改善心肌收缩力的同时, 避免诱发心律失常和对循环血管系统阻力不良影响;探索合适的体外膜肺氧合等介入时机。本文围绕SIC的液体管理、血管活性药物治疗和机械辅助、新型靶向药物研发等进展进行综述。Sepsis cardiomyopathy(SIC)is sepsis complicated with heart dysfunction,and its definition,pathogenesis,diagnostic criteria and therapeutic measures have not been well established.The reported prevalence of SIC varied from 10%to 70%and the diagnosis based on the measures of heart function and biological markers.The most important indicator is reduced left heart ejection fraction.Currently,it is believed that SIC should avoid rapid high-dose liquid treatment on the basis of infection treatment.The use of inotropic drugs needs to consider the improvement of myocardial contractility and avoid inducing arrhythmia and adverse effects on vascular resistance.The appropriate timing of extracorporeal membrane oxygenation support is still be challenged.The review focusesd on the fluid management and progress,vasoactive drug therapy and mechanical assistance,and the development of novel targeted drugs in SIC.

关 键 词：脓毒症心肌病 治疗 正性肌力药物 体外生命支持 

分 类 号：R459.7[医药卫生—急诊医学]