Schultz Marcus J, Haitsma Jack J, Zhang Haibo, Slutsky Arthur S
Department of Intensive Care Medicine, University of Amsterdam, Netherlands, and the Interdepartmental Division of Critical Care, St. Michael's Hospital, Toronto, ON, Canada.
Crit Care Med. 2006 Mar;34(3):871-7.
To review the involvement of coagulation and fibrinolysis in the pathogenesis of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS), pulmonary infection, and ventilator-induced lung injury (VILI).
Published articles on experimental and clinical studies of coagulation and fibrinolysis in ALI/ARDS, pneumonia, and mechanical ventilation.
Alveolar fibrin deposition is an important feature of ALI/ARDS and pulmonary infection. The mechanisms that contribute to disturbed alveolar fibrin turnover are localized tissue factor-mediated thrombin generation and depression of bronchoalveolar urokinase plasminogen activator-mediated fibrinolysis, caused by the increase of plasminogen activator inhibitors. These effects on pulmonary coagulation and fibrinolysis are regulated by various proinflammatory cytokines and are similar to those found in the intravascular spaces during severe systemic inflammation. Some studies also suggest that pulmonary coagulopathy is a feature of VILI. Recent studies have demonstrated the beneficial effect of anticoagulant therapy in sepsis. Theoretical considerations suggest that this anticoagulant therapy will benefit patients with primary lung pathology including VILI, but clinical studies are needed to examine this hypothesis before such therapy is to be advocated as a standard of care in critically ill patients.
综述凝血和纤溶在急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）、肺部感染及呼吸机诱导性肺损伤（VILI）发病机制中的作用。
关于ALI/ARDS、肺炎及机械通气中凝血和纤溶的实验及临床研究的已发表文章。
肺泡纤维蛋白沉积是ALI/ARDS和肺部感染的一个重要特征。导致肺泡纤维蛋白周转紊乱的机制是局部组织因子介导的凝血酶生成以及纤溶酶原激活物抑制剂增加所致的支气管肺泡尿激酶型纤溶酶原激活物介导的纤溶功能降低。这些对肺凝血和纤溶的影响受多种促炎细胞因子调控，且与严重全身炎症期间血管内所见的情况相似。一些研究还提示肺凝血病是VILI的一个特征。近期研究已证实抗凝治疗在脓毒症中的有益作用。理论上认为这种抗凝治疗对包括VILI在内的原发性肺部病变患者有益，但在将这种治疗作为重症患者的标准治疗方法提倡之前，需要进行临床研究来验证这一假说。
