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脓毒症是由感染引起的全身炎症反应综合征,证实有感染灶存在或有高度可疑的感染灶。脓毒症是ICU内重症患者的主要死亡原因,且发病率随着年龄的增长而逐渐增加。近十年来,虽然政府在救治脓毒症患者中投入了巨大的资金和技术支持,但源于脓毒症或脓毒性休克患者的病死率仍高达30%~60%。心血管系统在脓毒症与脓毒性休克的病理生理学中扮演着重要着色。过去的四五十年,开展了很多脓毒性心肌功能障碍方面的研究,也积累了不少循证医学证据。然而,心脏只是心血管系统的一部分。诸如脓毒症患者机体血流动力学的变化系脓毒症对心脏的直接效应,还是脓毒症引起心脏前、后负荷及神经体液因素的变化,继而引起心脏继发改变的研究,至今仍在继续。本文概述了近年来脓毒性心肌功能障碍的研究进展,使读者更全面地了解脓毒性心肌功能障碍的病理生理学改变,合理有效地指导脓毒症和脓毒性休克患者的临床救治。
Sepsis is a systemic inflammatory response syndrome caused by infection, confirming the presence or presence of a highly suspicious foci. Sepsis is the leading cause of death in critically ill patients in the ICU and the incidence increases gradually with age. In the past decade, although the government invested tremendous financial and technical support in the treatment and treatment of sepsis, the mortality rate in patients with sepsis or septic shock is still as high as 30% -60%. The cardiovascular system plays an important role in the pathophysiology of sepsis and septic shock. Over the past four or five decades, many studies have been conducted on the pathogenesis of septic myocardial dysfunction and a great deal of evidence-based medicine has been accumulated. However, the heart is only part of the cardiovascular system. Changes such as sepsis in patients with hemodynamic changes in sepsis, the direct effect of the heart, or sepsis caused by heart before and after the load and changes in neurohumoral factors, which in turn lead to secondary changes in heart research, still Continue. This article summarizes the research progress of septic myocardial dysfunction in recent years so that readers can understand the pathophysiological changes of septic myocardial dysfunction more completely and guide the clinical treatment of sepsis and septic shock reasonably and effectively.