修慧卿　王冬英　许强宏　张根生

[摘要] 脓毒症（sepsis）是宿主对感染的反应失调，并产生危及生命的器官功能障碍，常发生在烧伤、感染、多发伤等临床急危重疾病的基础上，也是导致多器官功能障碍综合征（MODS）的重要原因之一，病情凶险，临床病死率高。脓毒症诱导的心肌抑制（sepsis-induced myocardial dysfunction，SIMD）是严重脓毒症和脓毒性休克常见的并发症之一，是导致脓毒症多器官功能障碍及其病死率增加的重要因素。一种新型钙增敏剂——左西孟旦，在失代偿性心衰治疗中发挥了较好的疗效，目前在脓毒症中也得到一定的应用，但是存在一定的争议。近年来对左西孟旦在脓毒症中的作用，国内外进行多项临床试验，现就其在脓毒症中的作用进展作一综述。

[关键词] 脓毒症；左西孟旦；心肌抑制；脓毒症性休克

[中图分类号] R459.7 [文献标识码] A [文章编号] 1673-9701（2017）36-0161-04

[Abstract] Sepsis is the response disorder of the host to infection， which produces life-threatening organ dysfunction and often occurs on the basis of clinical acute and critical diseases including burns， infections， multiple injuries， and is one of the important reasons leading to multiple organ dysfunction syndrome（MODS）. The disease is dangerous and has high clinical mortality. Sepsis-induced myocardial dysfunction（SIMD） is one of the most common complications of severe sepsis and septic shock， which is an important factor leading to the increase of multiple organ dysfunction and the mortality of sepsis. A new calcium sensitizer——levosimendan plays a very good effect in the treatment of decompensated heart failure， and also has a certain application in sepsis. But there is a certain controversy. In recent years， a number of clinical trials at home and abroad on the role of levosimendan in sepsis have been carried out. The progress of the role of levosimendan in the treatment of sepsis will be reviewed in this paper.

[Key words] Sepsis； Levosimendan； Myocardial depression； Septic shock

膿毒症是宿主对感染的反应失调，产生危及生命的器官功能障碍[1]，可发展为严重脓毒症和脓毒性休克（由于既往的研究大都是在sepsis3.0定义之前，本文暂保留了严重脓毒症的概念）。脓毒症诱导的心肌抑制（sepsis-induced myocardial dysfunction，SIMD）主要表现为左、右心室射血分数的下降及舒张功能的减退，是脓毒症和脓毒性休克常见的并发症[2]。临床上约50%的脓毒性休克患者存在不同程度的心功能抑制[3]，一旦合并心肌抑制，其死亡率高达70%～90%[4]。所以，早发现、早治疗、减少心肌耗氧量、提升心输出量以及保护心脏功能显得尤为重要。左西孟旦作为一种新型钙增敏剂，多用于失代偿性心衰[5]、冠状动脉疾病[6]以及心脏手术后[7]，最近其在严重脓毒症和脓毒性休克中的应用也越来越受到人们的关注。……