姜国良,甘桂芬

脓毒症是急性呼吸窘迫综合征（ARDS）的主要肺外诱因，二者并存时死亡率高达71%。脓毒症中的炎症介质对肺的损伤推动ARDS进展；肺泡动脉氧分压梯度[D(A-a)O2]作为评估肺换气效率的敏感指标，在ARDS早期因肺泡膜损伤和通气/血流比例（V/Q）失调显著升高，且与病情严重程度呈正相关，动态监测可反映治疗效果。二者协同作用：炎症介质水平升高标志全身炎症反应加剧，D(A-a)O2升高标志肺换气障碍，联合应用可更精准评估肺损伤程度与预后。二者联合指标为脓毒症相关ARDS的分层管理提供新策略，有望指导个体化治疗以提高生存率。本文将综述炎症介质与肺泡动脉氧分压梯度【D(A-a)O2】在脓毒症相关ARDS中的相互作用及临床意义。

炎症介质；肺泡动脉氧分压梯度[D(A-a)O2]；脓毒症；急性呼吸窘迫综合征（ARDS）；预后分析

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