Department of Intensive Care, City General Hospital, North Staffordshire NHS Trust, Newcastle Road, Stoke-on-Trent ST4 7PS, UK.
Environ Toxicol Pharmacol. 2001 Sep;10(4):183-8. doi: 10.1016/s1382-6689(01)00082-5.
Critically ill patients in the intensive care unit (ICU) present with a variety of different pathologies, and mortality is high despite extensive multi-organ supportive treatment. Reactive oxygen species (ROS) are believed to play a pivotal role in the pathophysiology of organ dysfunction in the ICU. In particular, the role of ROS as a final common pathway of cell damage has been increasingly emphasised in the adult respiratory distress syndrome (ARDS), in central nervous system traumatic and hypoxic states, and as a cause of ischaemic neurological deficits after subarachnoid haemorrhage. Measurement of total antioxidant status (TAS) has shown improved survival of patients with high TAS and poorer outcomes for those with lower values. Attempts to supplement endogenous antioxidant defences have not demonstrated clear benefits in randomised clinical trials, and the use of free radical scavenging agents have had similar mixed results. Considering the wide variation in the nature and severity of illness in the intensive care population, it is not surprising that clear evidence of the efficacy of antioxidant therapies in improving survival has not been clearly demonstrated. However, single component therapies for complex pathophysiological processes are rarely successful, and the role of antioxidants in the critically ill should be thought of as only part of a rational and logical therapeutic approach.
重症监护病房（ICU）中的危重症患者表现出多种不同的病理，尽管进行了广泛的多器官支持治疗，死亡率仍然很高。活性氧（ROS）被认为在 ICU 中器官功能障碍的病理生理学中起关键作用。特别是，ROS 作为细胞损伤的最终共同途径的作用在成人呼吸窘迫综合征（ARDS）、中枢神经系统创伤和缺氧状态以及蛛网膜下腔出血后缺血性神经功能缺损的原因中得到了越来越多的强调。总抗氧化状态（TAS）的测量表明，TAS 较高的患者生存率提高，而 TAS 较低的患者预后较差。在随机临床试验中，补充内源性抗氧化防御的尝试并未显示出明确的益处，自由基清除剂的使用也产生了类似的混合结果。考虑到 ICU 人群中疾病的性质和严重程度差异很大，抗氧化治疗在提高生存率方面的疗效没有得到明确证实也就不足为奇了。然而，对于复杂的病理生理过程，单一成分的治疗方法很少成功，因此，应将抗氧化剂在危重病患者中的作用仅视为合理和逻辑治疗方法的一部分。
