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严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染导致的新型冠状病毒肺炎(COVID-19)疫情正在全球肆虐。根据世界卫生组织公布的数据,截至2020年6月27日,全球累计报告COVID-19确诊人数9 653 048 人,死亡491 128 人[1]。研究发现,COVID-19极易导致有基础疾病的老人死亡,即使对于无基础性疾病、无重症高危因素、病情相对稳定的轻症患者,也有少部分会发生病情的突然恶化,并发急性呼吸窘迫综合征(ARDS)、脓毒性休克和多脏器功能障碍综合征(MODS)。重症患者常因肺损伤甚至多器官功能障碍而死亡[2]。
脓毒症是机体对感染的免疫反应失调所导致的危及生命的多器官功能障碍。COVID-19重症或危重症患者免疫系统异常激活,发生细胞因子风暴,炎症后期外周淋巴计数持续降低,出现循环障碍、肢冷、脉搏细弱、严重肺损伤,有的合并肝、肾等多脏器功能受损,表现出脓毒症的典型特征,符合脓毒症诊断标准(sequential organ failure assessment, SOFA评分较基线上升≥2)。免疫反应失调是脓毒症发生的核心机制[3],医药学专家对COVID-19病毒性脓毒症的临床表现和发病机制进行了研究,探索了治疗策略,总结了临床经验[4]。
Advances in treatment strategies for COVID-19 viral sepsis
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摘要: 新型冠状病毒肺炎(COVID-19)已造成全球疫情并仍在持续蔓延。大量COVID-19重症或危重症患者的临床表现符合脓毒症和脓毒症休克的诊断标准,研究其发病机制和治疗策略对COVID-19的防控有重要意义。对COVID-19病毒性脓毒症的临床特征和治疗进展做一综述。
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关键词:
- 新型冠状病毒肺炎 /
- 严重急性呼吸综合征冠状病毒2 /
- 脓毒症 /
- 细胞因子风暴
Abstract: The corona virus disease 2019 (COVID-19) has recently become pandemic and is still spreading. Many severe or critical COVID-19 cases meet the diagnostic criteria of sepsis and septic shock in the clinical manifestations. It is important to study the pathogenesis and treatment strategy of COVID-19 for the disease prevention and control. This article reviews the clinical features and treatment progress of COVID-19 viral sepsis.-
Key words:
- COVID-19 /
- SARS-CoV-2 /
- sepsis /
- cytokine storm
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