Mishra Vinita
Department of Clinical Chemistry, Royal Liverpool University Hospital, Liverpool, UK.
Clin Lab. 2007;53(3-4):199-209.
Sepsis or systemic inflammatory response (SIRS) to infection or to non-infectious stimuli such as trauma, surgery, pancreatitis or ischemia, is an increasingly common cause of morbidity and mortality in patients on intensive therapy unit (ITU). In critically ill patients, this accounts for 10% to 50% of all deaths. Oxidative stress has an important role in the development and manifestations of SIRS. Oxidative stress is an imbalance between the free radical production and the antioxidant defense. In critical illness, overwhelming inflammatory mediator response to infective or non-infective stimuli results in excessive production of free radicals (FR). The action of FR is normally limited by the antioxidant defense system of the body, but in critically ill patients the antioxidant capacity is likely to be compromised. Hence, provision of antioxidants to critically ill patients may help in removing the FR and therefore improving the clinical outcome. However, no study has yet provided conclusive evidence of the beneficial effect of antioxidant supplementation in critically ill patients. The clinical evidence provided so far shows that there are several factors which might determine the efficacy of antioxidant supplementation in critically ill patients. There is a need for large multicentre prospective randomized control trials to assess the effects of different types and doses of antioxidant supplementation in selected groups of patients with different types of critical illness.
脓毒症或对感染或非感染性刺激（如创伤、手术、胰腺炎或局部缺血）的全身炎症反应（SIRS），是重症监护病房（ITU）患者发病和死亡日益常见的原因。在危重症患者中，这占所有死亡人数的10%至50%。氧化应激在SIRS的发生和表现中起重要作用。氧化应激是自由基产生与抗氧化防御之间的失衡。在危重症中，对感染性或非感染性刺激的过度炎症介质反应导致自由基（FR）过度产生。FR的作用通常受到机体抗氧化防御系统的限制，但在危重症患者中，抗氧化能力可能会受损。因此，为危重症患者提供抗氧化剂可能有助于清除FR，从而改善临床结局。然而，尚无研究提供确凿证据证明抗氧化剂补充对危重症患者有益。目前提供的临床证据表明，有几个因素可能决定抗氧化剂补充对危重症患者的疗效。需要进行大型多中心前瞻性随机对照试验，以评估不同类型和剂量的抗氧化剂补充对不同类型危重症患者选定组别的影响。
