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西方和第三世界将社会获得性肺炎均列为五种主要死因之一,尽管有效抗菌药物应用,其死亡率为6％～24％,在ICU病房达53％～76％。对此种具有免疫力的肺炎抗菌治疗后仍死亡的原因尚不清楚,作者推测用杀菌性抗生素后细菌溶解和抗原释放,引起肿瘤坏死因子(TNF-α)产生的“第二波”,伴以进行性肺损伤和多脏器功能不全综合征(MOPS)。近期研究低剂量皮质激素可抑制TNF-α的产生,阻止“第二波”。作者研究了30例收入ICU病房的重症社会获得性肺炎患者,符合英国胸腔协会重症肺炎标准3个或3个以上:①呼吸>30/min,②舒张期血压<8kPa(<60mmHg.1KPa=7.5mmHg),③意识模糊.④PaO_2<7.3kPa,⑤WBC<4或>30×10_9/L,⑥血清尿素>7mmol/L,⑦血小板<140×10_9/L,⑧X线上多叶受累;并排除对β
Both Western and Third Worlds list socially acquired pneumonia as one of the five leading causes of death, with 6% to 24% mortality and 53% to 76% in ICU wards despite effective antimicrobial use. The reason for the death of such immunocompetent pneumonia following antibacterial therapy remains unclear. The authors speculate that bacterial dissolution and antigen release following bactericidal antibiotics cause the “second wave” of tumor necrosis factor (TNF-α) production, With progressive lung injury and multiple organ dysfunction syndrome (MOPS). Recent studies of low-dose corticosteroids can inhibit the production of TNF-α, to prevent the “second wave.” The authors studied 30 patients with severe acquired pneumonia in ICU wards who met the British Thoracic Society criteria for severe pneumonia by 3 or more: ① breathing> 30 / min, ② diastolic blood pressure <8 kPa (<60 mm Hg, 1 KPa = 7.5 mmHg), ③ confusion. ④PaO_2 <7.3kPa, ⑤ WBC <4 or> 30 × 10_9 / L, ⑥ serum urea> 7mmol / L, ⑦ platelets <140 × 10_9 / L, ⑧ X line multiple leaves involved; β