脓毒症是危重病主要死亡原因之一,脓毒症发病后的长期免疫抑制是其远期高病死率的主要原因.认识脓毒症免疫动力学及其免疫抑制,对防止和减轻免疫抑制,降低病死率有重要意义.脓毒症早期呈高炎症反应状态,在炎症损伤组织细胞的同时,也引起免疫细胞损伤致免疫抑制,这是脓毒症免疫抑制的基础;中期呈混合性免疫状态,炎症和抗炎机制相互抗衡,炎症损伤继续,免疫功能进一步抑制;后期若病情进一步恶化,免疫抑制严重,导致免疫功能低下并最终发展成免疫麻痹.依据免疫动力学和免疫抑制的应对尚未有特效疗法,有待进一步研究.%Sepsis is the leading cause of death among critically ill patients.The long-term immunosuppression after recovery of an acute sepsis event is a major reason for the high mortality rate in long term outcomes.Understanding immunodynamics of sepsis and its immunosuppression is very important to prevent and reduce the immunosuppression,decrease mortality.Hyperinflammation is in the early stage of the immunodynamics of sepsis.The exorbitant release of inflammatory mediator and cytokines impairs tissue cells in inflammatory reaction,and at the same time,also causes immune cells damage and immune suppression consequently,which is the basis of sepsis immunosuppression.Middle stage of sepsis is mixed immune status.During this pcriod,inflammatory and anti-inflammatory mechanism compete with each other,while the inflammatory lesions continue and immune function is further restrained;in the later stage of sepsis,further deterioration and severer immunosuppression leads to immune dysfunction,and immunoparalysis in the end.There is no specific therapy for immunosuppression according to immunodynamics,and further researche is needed.
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