摘要
机械通气相关肺损伤(ventilator-induced lung injury,VILI)是重症患者治疗中的严重并发症。肺血管内皮功能障碍在VILI中扮演核心角色。肺血管内皮功能障碍是一种多因素、多机制交互下的复杂病理生理状态。本文从机械力直接损伤与屏障功能破坏、炎症反应与细胞因子释放、氧化应激与线粒体功能障碍和补体激活、凝血-纤溶系统失衡四个方面的研究进展进行总结,探讨了机械通气优化策略、药物干预、生物治疗的作用及疗效,系统总结了肺血管内皮功能障碍在VILI中的多维度机制及防治进展,旨在为进一步基础研究和临床实践提供理论依据。
Ventilator-induced lung injury(VILI),a critical complication in the management of critically ill patients,is closely linked to pulmonary vascular endothelial dysfunction.This dysfunction represents a multifactorial pathophysiological state involving intricate crosstalk among diverse mechanisms.This review systematically examines recent progress in four principal dimensions:direct mechanical stress-induced endothelial injury and barrier disruption;inflammatory responses and cytokine release;oxidative stress,mitochondrial dysfunction and complement activation coupled;and coagulation-fibrinolysis imbalance.Furthermore,we evaluate current therapeutic strategies,including optimized ventilator protocols,pharmacological interventions,and emerging biotherapies,emphasizing their mechanistic rationale and clinical efficacy.By synthesizing the multidimensional mechanisms and therapeutic advancements in VILI endothelial pathology,this review aims to inform future basic research and clinical practice.
作者
张海琨
曹乐
于晋祥
张念亮
赵涛
ZHANG Haikun;CAO Le;YU Jinxiang;ZHANG Nianliang;ZHAO Tao(School of Anesthesiology,Shandong Second Medical University,Weifang 261053,China;Shandong Provincial Key Medical and Health Laboratory of Perioperative Precise Anesthesia and Organ Protection Mechanism Research,Rizhao Key Laboratory of Basic Research on Anesthesia and Respiratory Intensive Care,Department of Anesthesiology,People's Hospital of Rizhao,Rizhao 276826,China)
出处
《生命的化学》
2025年第6期967-974,共8页
Chemistry of Life
基金
泰山学者青年专家项目(tsqn202211380)
山东省卫生健康科创团队建设项目
中国博士后科学基金项目(2023M741864)
山东省医药卫生科技项目(202318001632)
日照市中医药科技项目重点项目(RZY2022A01)。
关键词
机械通气相关肺损伤
肺血管内皮功能障碍
屏障破坏
炎症反应
氧化应激
ventilator-induced lung injury
pulmonary vascular endothelial dysfunction
barrier disruption
inflammatory responses
oxidative stress
