Schoenberg M H, Nüssler A K, Beger H G
Chirurgische Klinik I, Universität Ulm.
Chirurg. 1995 Jan;66(1):18-26.
Accumulation and stimulation of PMN-leukocytes, enhanced prostaglandin metabolism and tissue hypoxia lead to high concentrations of oxygen radicals and their metabolites in septic shock. Synchroneously, excessive high concentrations of nitric oxide are found, most likely due to the stimulation of its inducible synthetase. Oxygen radicals seem to be attributable for the irreversible tissue damage leading to multiple organ failure in sepsis. High concentrations of nitric oxide induce the typical macro- and microcirculatory derangements normally seen in sepsis. Both mediators are present in the early phase of sepsis and seem to influence the course of disease. Therapeutic interventions such as scavenger therapy or inhibition of the inducible NO-synthetase are promising. The results of the first clinical therapeutic studies, however, were not always conclusive. It is still unclear which scavenger and which inhibitor should be given when and in which dosage in order to improve the outcome of sepsis and septic shock. Furthermore, it remains unclear to which extend oxygen radicals and nitric oxide react with each other, thus possibly potentiating their effects. The open questions still warrant further research and may lead to new therapeutic options improving the morbidity and mortality of this severe disease.
中性粒细胞的聚集与激活、前列腺素代谢增强以及组织缺氧导致脓毒症休克时氧自由基及其代谢产物浓度升高。同时，发现存在过高浓度的一氧化氮，这很可能是由于其诱导型合酶受到刺激所致。氧自由基似乎是导致脓毒症中不可逆组织损伤并引发多器官功能衰竭的原因。高浓度的一氧化氮会引发脓毒症中常见的典型宏观和微观循环紊乱。这两种介质在脓毒症早期均存在，且似乎会影响疾病进程。清除剂疗法或抑制诱导型一氧化氮合酶等治疗干预措施具有前景。然而，首批临床治疗研究的结果并不总是确凿无疑的。目前仍不清楚何时应以何种剂量给予何种清除剂和抑制剂，才能改善脓毒症和脓毒症休克的预后。此外，氧自由基与一氧化氮相互反应的程度仍不明确，它们可能因此增强彼此的作用。这些悬而未决的问题仍需进一步研究，可能会带来改善这种严重疾病发病率和死亡率的新治疗选择。
