Research progress on pathogenic mechanism and treatment strategy of seawater induced acute lung injury_West China Medical Journal

Authors：

LI Tianfei ^1,2 , ZHANG Hao ² , WEI Liangfeng ² ,  WANG Shousen ²

1. Department of Cerebral Surgery, Bozhou Hospital of Traditional Chinese Medicine, Bozhou, Anhui 236800, P. R. China;
2. Department of Neurosurgery, the 900th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Fuzhou, Fujian 350025, P. R. China;

Corresponding?author：

WANG Shousen, Email: wshsen@126.com

Keywords：

Seawater drowning; lung injury; seawater induced acute lung injury; pathogenic mechanism; treatment strategy

DOI：

10.7507/1002-0179.202309006

Video：

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Abstract Full text Figures/Tables Video References Cited by

Seawater drowning leads to acute lung tissue structure injury, lung ventilation and air exchange dysfunction, acute pulmonary edema, and even acute respiratory failure. The pathogenesis of seawater induced acute lung injury is complex, involving inflammatory response, pulmonary edema, pulmonary surfactant, oxidative stress, apoptosis and autophagy. Timely and effective treatment is the key to reduce the mortality and disability rate of patients with seawater induced acute lung injury. This article summarizes the research progress in the pathogenic mechanism and treatment strategy of seawater induced acute lung injury, aiming to provide reference for the comprehensive treatment of seawater induced acute lung injury patients in clinical work and subsequent related research.

Citation： LI Tianfei, ZHANG Hao, WEI Liangfeng, WANG Shousen. Research progress on pathogenic mechanism and treatment strategy of seawater induced acute lung injury. West China Medical Journal, 2024, 39(1): 147-152. doi: 10.7507/1002-0179.202309006 Copy

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4.	鐘旺旺, 魏梁鋒, 陳偉強, 等. 大鼠創傷性腦損傷合并海水淹溺性急性肺損傷模型的建立. 中華航海醫學與高氣壓醫學雜志, 2019, 26(4): 267-271.
5.	董文度, 趙增榮, 張敏華, 等. 兔海水淹溺肺水腫時肺損傷及其機理研究. 中華航海醫學雜志, 1998, 5(1): 16-19.
6.	張春陽, 李亮, 張寧坤, 等. 氣管植入間充質干細胞聯合部分液體通氣對海水淹溺致肺損傷大鼠治療作用的研究. 臨床肺科雜志, 2021, 26(11): 1680-1685.
7.	孔敏, 徐淼, 和秋莉, 等. 俯臥位通氣對海水淹溺型急性呼吸窘迫綜合征大鼠的治療作用. 中國現代醫生, 2021, 59(11): 26-29,35.
8.	程志鵬, 劉金霞, 蘇程程, 等. 全氟化碳霧化吸入對大鼠海水吸入性肺損傷治療作用研究. 解放軍醫學學報, 2023, 44(5): 508-513.
9.	仲崇翔, 廖日洪. 海水淹溺患者體內生化指標的變化分析. 臨床醫學, 2012, 32(9): 49-50.
10.	逄忠利, 梁軍濤, 趙永茂, 等. 海水淹溺患者心電圖變化及影響因素. 中國療養醫學, 2010, 19(3): 266.
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12.	Li C, Liu M, Bo L, et al. NFAT5 participates in seawater inhalation-induced acute lung injury via modulation of NF-κB activity. Mol Med Rep, 2016, 14(6): 5033-5040.
13.	Chen M, Lin HG, Gao Y, et al. Ghrelin attenuates drowning injury via dual effects on damage protection and immune repression. Ann Transl Med, 2021, 9(11): 920.
14.	Zhang M, Jin F. 1α, 25-dihydroxyvitamin D3 ameliorates seawater aspiration-induced lung injury by inhibiting the translocation of NF-κB and RhoA. Inflammation, 2017, 40(3): 832-839.
15.	Liu Z, Zhang B, Wang XB, et al. Hypertonicity contributes to seawater aspiration-induced lung injury: role of hypoxia-inducible factor 1α. Exp Lung Res, 2015, 41(6): 301-315.
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18.	萬斌斌, 劉鋼, 袁佳寧, 等. 血紅素加氧酶-1 抑制 M1 巨噬細胞極化對海水淹溺性肺損傷小鼠的保護作用. 中華航海醫學與高氣壓醫學雜志, 2021, 28(3): 350-355.
19.	Sun XQ, Wu C, Qiu YB, et al. Heme oxygenase-1 attenuates seawater drowning-induced acute lung injury through a reduction in inflammation and oxidative stress. Int Immunopharmacol, 2019, 74: 105634.
20.	Wang WB, Li JT, Hui Y, et al. Combination of pseudoephedrine and emodin ameliorates LPS-induced acute lung injury by regulating macrophage M1/M2 polarization through the VIP/cAMP/PKA pathway. Chin Med, 2022, 17(1): 19.
21.	Fan Q, Zhao P, Li J, et al. 17β-Estradiol administration attenuates seawater aspiration-induced acute lung injury in rats. Pulm Pharmacol Ther, 2011, 24(6): 673-681.
22.	Xie XY, Zhang B, Li JH, et al. Sodium tanshinone iia sulfonate attenuates seawater aspiration-induced acute pulmonary edema by up-regulating Na (+), K (+)-ATPase activity. Exp Lung Res, 2011, 37(8): 482-491.
23.	Liu T, Li Y, Zhang B, et al. The role of phosphorylated Cx43 on PKC mediated Ser368 in lung injury induced by seawater inhalation. Inflammation, 2015, 38(5): 1847-1854.
24.	張春陽, 田光. 淹溺與肺損傷及其治療. 中國臨床醫生雜志, 2016, 44(1): 10-12.
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26.	王瑛, 姚曉光, 李南方, 等. 肺泡表面活性物質特點及功能研究進展. 醫學研究雜志, 2019, 48(11): 180-183.
27.	李毅, 鄒日坤, 蔣富強, 等. 大劑量氨溴索對海水浸泡致急性肺損傷犬體內SP-A、SP-B含量的影響. 海南醫學院學報, 2014, 20(8): 1038-1040.
28.	王小川, 杜發旺, 姚宇, 等. 西格列汀通過上調TTF-1/SP-B通路對LPS誘導小鼠急性肺損傷的保護作用. 西南醫科大學學報, 2023, 46(6): 495-499.
29.	喬永平, 劉軼寧. IL-8 及 SPB 蛋白在兔海水及淡水淹溺型急性肺損傷模型中的表達. 臨床肺科雜志, 2020, 25(4): 574-577, 609.
30.	Qiu YB, Wan BB, Liu G, et al. Nrf2 protects against seawater drowning-induced acute lung injury via inhibiting ferroptosis. Respir Res, 2020, 21(1): 232.
31.	杜斌, 朱丹, 溫媛婷, 等. 小劑量肝素對小鼠淹溺肺損傷 SOD、MPO 活性和 MDA 水平的影響. 中國應用生理學雜志, 2017, 33(5): 469-470, 475.
32.	Legaz I, Barrera-Pérez E, Sibón A, et al. Combining oxidative stress markers and expression of surfactant protein A in lungs in the diagnosis of seawater drowning. Life (Basel), 2023, 13(1): 159.
33.	段銳, 金發光. TGF-β1/Smad2 信號通路參與海水淹溺肺損傷引起的細胞凋亡. 中華肺部疾病雜志(電子版), 2020, 13(2): 154-158.
34.	Li PC, Wang BR, Li CC, et al. Seawater inhalation induces acute lung injury via ROS generation and the endoplasmic reticulum stress pathway. Int J Mol Med, 2018, 41(5): 2505-2516.
35.	Bo L, Li Y, Liu W, et al. Selective inhibition of JNK mitochondrial location is protective against seawater inhalation-induced ALI/ARDS. Mol Med Rep, 2021, 24(1): 515.
36.	Zhang ML, Gao Y, Zhao W, et al. ACE-2/ANG1-7 ameliorates ER stress-induced apoptosis in seawater aspiration-induced acute lung injury. Am J Physiol Lung Cell Mol Physiol, 2018, 315(6): L1015-L1027.
37.	韓志海, 段蘊鈾, 劉于紅, 等. 控制性肺膨脹治療海水淹溺肺損傷兔的實驗研究. 中國急救醫學, 2007, 27(5): 440-442,482.
38.	王飛, 張文祥. 淡水淹溺重癥患者的機械通氣策略及預防. 疾病監測與控制, 2013, 7(12): 730-732.
39.	王穎, 唐志華. 高壓氧綜合治療海水淹溺性肺水腫 20 例療效觀察. 中華航海醫學與高氣壓醫學雜志, 2020, 27(1): 107-109.
40.	??k N, ?enol HB, ?a?lar A, et al. Early application of non-invasive ventilation for children with pulmonary edema after drowning. Pediatr Int, 2022, 64(1): e14858.
41.	張兵華, 費晉秀, 趙亞玲, 等. 不同劑量地塞米松對兔海水淹溺性肺水腫血清氧自由基的影響. 中國現代醫學雜志, 2011, 21(20): 2338-2342.
42.	孫玉紅. 甲強龍在海水溺水致急性肺水腫院前急救中的效果觀察. 中國實用醫藥, 2022, 17(6): 149-151.
43.	韓璐瑤, 高永恒, 魚高樂, 等. 地塞米松聯合肌肽在海水淹溺性肺損傷中的治療作用. 中華結核和呼吸雜志, 2020, 43(9): 772-777.
44.	謝曉燕, 王永興, 敬梅, 等. 丹參酮ⅡA 磺酸鈉對海水淹溺性肺水腫大鼠的作用及其機制. 中華航海醫學與高氣壓醫學雜志, 2013, 20(2): 86-90.
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1. Szpilman D, Morgan PJ. Management for the drowning patient. Chest, 2021, 159(4): 1473-1483.
2. Reizine F, Delbove A, Santos AD, et al. Clinical spectrum and risk factors for mortality among seawater and freshwater critically ill drowning patients: a French multicenter study. Crit Care, 2021, 25(1): 372.
3. 馮慶國, 安友仲, 魏凱, 等. 等量淡水淹溺與海水淹溺對綿羊肺循環血流動力學及呼吸力學影響的隨機對照研究. 中華危重病急救醫學, 2020, 32(2): 177-182.
4. 鐘旺旺, 魏梁鋒, 陳偉強, 等. 大鼠創傷性腦損傷合并海水淹溺性急性肺損傷模型的建立. 中華航海醫學與高氣壓醫學雜志, 2019, 26(4): 267-271.
5. 董文度, 趙增榮, 張敏華, 等. 兔海水淹溺肺水腫時肺損傷及其機理研究. 中華航海醫學雜志, 1998, 5(1): 16-19.
6. 張春陽, 李亮, 張寧坤, 等. 氣管植入間充質干細胞聯合部分液體通氣對海水淹溺致肺損傷大鼠治療作用的研究. 臨床肺科雜志, 2021, 26(11): 1680-1685.
7. 孔敏, 徐淼, 和秋莉, 等. 俯臥位通氣對海水淹溺型急性呼吸窘迫綜合征大鼠的治療作用. 中國現代醫生, 2021, 59(11): 26-29,35.
8. 程志鵬, 劉金霞, 蘇程程, 等. 全氟化碳霧化吸入對大鼠海水吸入性肺損傷治療作用研究. 解放軍醫學學報, 2023, 44(5): 508-513.
9. 仲崇翔, 廖日洪. 海水淹溺患者體內生化指標的變化分析. 臨床醫學, 2012, 32(9): 49-50.
10. 逄忠利, 梁軍濤, 趙永茂, 等. 海水淹溺患者心電圖變化及影響因素. 中國療養醫學, 2010, 19(3): 266.
11. Ji MH, Tong JH, Tan YH, et al. Erythropoietin pretreatment attenuates seawater aspiration-induced acute lung injury in rats. Inflammation, 2016, 39(1): 447-456.
12. Li C, Liu M, Bo L, et al. NFAT5 participates in seawater inhalation-induced acute lung injury via modulation of NF-κB activity. Mol Med Rep, 2016, 14(6): 5033-5040.
13. Chen M, Lin HG, Gao Y, et al. Ghrelin attenuates drowning injury via dual effects on damage protection and immune repression. Ann Transl Med, 2021, 9(11): 920.
14. Zhang M, Jin F. 1α, 25-dihydroxyvitamin D3 ameliorates seawater aspiration-induced lung injury by inhibiting the translocation of NF-κB and RhoA. Inflammation, 2017, 40(3): 832-839.
15. Liu Z, Zhang B, Wang XB, et al. Hypertonicity contributes to seawater aspiration-induced lung injury: role of hypoxia-inducible factor 1α. Exp Lung Res, 2015, 41(6): 301-315.
16. Li C, Bo L, Liu Q, et al. Activation of TRPV1-dependent calcium oscillation exacerbates seawater inhalation-induced acute lung injury. Mol Med Rep, 2016, 13(3): 1989-1998.
17. 王保健, 毛旭, 等. 槲皮素通過抑制肺巨噬細胞的 M1 極化減輕海水吸入誘導的小鼠急性肺損傷. 細胞與分子免疫學雜志, 2017, 33(6): 751-755.
18. 萬斌斌, 劉鋼, 袁佳寧, 等. 血紅素加氧酶-1 抑制 M1 巨噬細胞極化對海水淹溺性肺損傷小鼠的保護作用. 中華航海醫學與高氣壓醫學雜志, 2021, 28(3): 350-355.
19. Sun XQ, Wu C, Qiu YB, et al. Heme oxygenase-1 attenuates seawater drowning-induced acute lung injury through a reduction in inflammation and oxidative stress. Int Immunopharmacol, 2019, 74: 105634.
20. Wang WB, Li JT, Hui Y, et al. Combination of pseudoephedrine and emodin ameliorates LPS-induced acute lung injury by regulating macrophage M1/M2 polarization through the VIP/cAMP/PKA pathway. Chin Med, 2022, 17(1): 19.
21. Fan Q, Zhao P, Li J, et al. 17β-Estradiol administration attenuates seawater aspiration-induced acute lung injury in rats. Pulm Pharmacol Ther, 2011, 24(6): 673-681.
22. Xie XY, Zhang B, Li JH, et al. Sodium tanshinone iia sulfonate attenuates seawater aspiration-induced acute pulmonary edema by up-regulating Na (+), K (+)-ATPase activity. Exp Lung Res, 2011, 37(8): 482-491.
23. Liu T, Li Y, Zhang B, et al. The role of phosphorylated Cx43 on PKC mediated Ser368 in lung injury induced by seawater inhalation. Inflammation, 2015, 38(5): 1847-1854.
24. 張春陽, 田光. 淹溺與肺損傷及其治療. 中國臨床醫生雜志, 2016, 44(1): 10-12.
25. 高習文, 修清玉, 孫波, 等. 海水淹溺肺水腫大鼠肺表面活性物質磷脂的變化. 第二軍醫大學學報, 2005(8): 903-906.
26. 王瑛, 姚曉光, 李南方, 等. 肺泡表面活性物質特點及功能研究進展. 醫學研究雜志, 2019, 48(11): 180-183.
27. 李毅, 鄒日坤, 蔣富強, 等. 大劑量氨溴索對海水浸泡致急性肺損傷犬體內SP-A、SP-B含量的影響. 海南醫學院學報, 2014, 20(8): 1038-1040.
28. 王小川, 杜發旺, 姚宇, 等. 西格列汀通過上調TTF-1/SP-B通路對LPS誘導小鼠急性肺損傷的保護作用. 西南醫科大學學報, 2023, 46(6): 495-499.
29. 喬永平, 劉軼寧. IL-8 及 SPB 蛋白在兔海水及淡水淹溺型急性肺損傷模型中的表達. 臨床肺科雜志, 2020, 25(4): 574-577, 609.
30. Qiu YB, Wan BB, Liu G, et al. Nrf2 protects against seawater drowning-induced acute lung injury via inhibiting ferroptosis. Respir Res, 2020, 21(1): 232.
31. 杜斌, 朱丹, 溫媛婷, 等. 小劑量肝素對小鼠淹溺肺損傷 SOD、MPO 活性和 MDA 水平的影響. 中國應用生理學雜志, 2017, 33(5): 469-470, 475.
32. Legaz I, Barrera-Pérez E, Sibón A, et al. Combining oxidative stress markers and expression of surfactant protein A in lungs in the diagnosis of seawater drowning. Life (Basel), 2023, 13(1): 159.
33. 段銳, 金發光. TGF-β1/Smad2 信號通路參與海水淹溺肺損傷引起的細胞凋亡. 中華肺部疾病雜志(電子版), 2020, 13(2): 154-158.
34. Li PC, Wang BR, Li CC, et al. Seawater inhalation induces acute lung injury via ROS generation and the endoplasmic reticulum stress pathway. Int J Mol Med, 2018, 41(5): 2505-2516.
35. Bo L, Li Y, Liu W, et al. Selective inhibition of JNK mitochondrial location is protective against seawater inhalation-induced ALI/ARDS. Mol Med Rep, 2021, 24(1): 515.
36. Zhang ML, Gao Y, Zhao W, et al. ACE-2/ANG1-7 ameliorates ER stress-induced apoptosis in seawater aspiration-induced acute lung injury. Am J Physiol Lung Cell Mol Physiol, 2018, 315(6): L1015-L1027.
37. 韓志海, 段蘊鈾, 劉于紅, 等. 控制性肺膨脹治療海水淹溺肺損傷兔的實驗研究. 中國急救醫學, 2007, 27(5): 440-442,482.
38. 王飛, 張文祥. 淡水淹溺重癥患者的機械通氣策略及預防. 疾病監測與控制, 2013, 7(12): 730-732.
39. 王穎, 唐志華. 高壓氧綜合治療海水淹溺性肺水腫 20 例療效觀察. 中華航海醫學與高氣壓醫學雜志, 2020, 27(1): 107-109.
40. ??k N, ?enol HB, ?a?lar A, et al. Early application of non-invasive ventilation for children with pulmonary edema after drowning. Pediatr Int, 2022, 64(1): e14858.
41. 張兵華, 費晉秀, 趙亞玲, 等. 不同劑量地塞米松對兔海水淹溺性肺水腫血清氧自由基的影響. 中國現代醫學雜志, 2011, 21(20): 2338-2342.
42. 孫玉紅. 甲強龍在海水溺水致急性肺水腫院前急救中的效果觀察. 中國實用醫藥, 2022, 17(6): 149-151.
43. 韓璐瑤, 高永恒, 魚高樂, 等. 地塞米松聯合肌肽在海水淹溺性肺損傷中的治療作用. 中華結核和呼吸雜志, 2020, 43(9): 772-777.
44. 謝曉燕, 王永興, 敬梅, 等. 丹參酮ⅡA 磺酸鈉對海水淹溺性肺水腫大鼠的作用及其機制. 中華航海醫學與高氣壓醫學雜志, 2013, 20(2): 86-90.
45. 田冶, 葛帥娜, 李軍, 等. 人參皂苷 Rg1 對大鼠海水淹溺性肺損傷的保護作用及其機制. 武警醫學, 2022, 33(2): 140-143.
46. 黃艷生, 文文, 賴國祥, 等. 白藜蘆醇對海水淹溺性肺損傷大鼠的保護作用研究. 中國呼吸與危重監護雜志, 2021, 20(8): 570-576.
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