Sepsis-induced myocardial dysfunction: pathophysiology and management.
Sepsis-induced myocardial dysfunction: pathophysiology and management.
复制标题
DOI：
10.1186/s40560-016-0148-1
复制
发表时间：
2016
影响因子：
7.1
通讯作者：
Yasuda T
中科院分区：
文献类型：
--
作者：
Kakihana Y;Ito T;Nakahara M;Yamaguchi K;Yasuda T
脓毒症是由不适当的免疫反应入侵微生物，这偶尔会导致多器官功能衰竭。有证据表明，脓毒症时心室肌受到抑制，表现为舒张功能障碍。脓毒性心肌病的潜在候选者包括病原体相关分子模式（PAMP），细胞因子和一氧化氮。作为内源性损伤相关分子模式（DAMP）的细胞外组蛋白和高迁移率族蛋白1也有助于脓毒症相关的心肌功能障碍。如果不治疗，持续性休克会导致细胞损伤和更多DAMP的释放。与PAMP一样，DAMP有可能激活炎症，形成恶性循环。在感染性休克期间，通过适当的抗生素护理进行早期感染控制以减少由侵入性微生物引起的PAMP是重要的。早期积极的液体复苏以及血管加压药和正性肌力药的给药对于减少受损细胞产生的DAMP也很重要，尽管过度的容量负荷和长期给予儿茶酚胺可能是有害的。本文综述了脓毒性心肌功能障碍的一些特点，评估其最常见的潜在机制，并简要概述了目前的治疗策略和潜在的未来方法。
Sepsis is aggravated by an inappropriate immune response to invading microorganisms, which occasionally leads to multiple organ failure. Several lines of evidence suggest that the ventricular myocardium is depressed during sepsis with features of diastolic dysfunction. Potential candidates responsible for septic cardiomyopathy include pathogen-associated molecular patterns (PAMPs), cytokines, and nitric oxide. Extracellular histones and high-mobility group box 1 that function as endogenous damage-associated molecular patterns (DAMPs) also contribute to the myocardial dysfunction associated with sepsis. If untreated, persistent shock causes cellular injury and the liberation of further DAMPs. Like PAMPs, DAMPs have the potential to activate inflammation, creating a vicious circle. Early infection control with adequate antibiotic care is important during septic shock to decrease PAMPs arising from invasive microorganisms. Early aggressive fluid resuscitation as well as the administration of vasopressors and inotropes is also important to reduce DAMPs generated by damaged cells although excessive volume loading, and prolonged administration of catecholamines might be harmful. This review delineates some features of septic myocardial dysfunction, assesses its most common underlying mechanisms, and briefly outlines current therapeutic strategies and potential future approaches.