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

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.	冯庆国, 安友仲, 魏凯, 等. 等量淡水淹溺与海水淹溺对绵羊肺循环血流动力学及呼吸力学影响的随机对照研究. 中华危重病急救医学, 2020, 32(2): 177-182.
4.	钟旺旺, 魏梁锋, 陈伟强, 等. 大鼠创伤性脑损伤合并海水淹溺性急性肺损伤模型的建立. 中华航海医学与高气压医学杂志, 2019, 26(4): 267-271.
5.	董文度, 赵增荣, 张敏华, 等. 兔海水淹溺肺水肿时肺损伤及其机理研究. 中华航海医学杂志, 1998, 5(1): 16-19.
6.	张春阳, 李亮, 张宁坤, 等. 气管植入间充质干细胞联合部分液体通气对海水淹溺致肺损伤大鼠治疗作用的研究. 临床肺科杂志, 2021, 26(11): 1680-1685.
7.	孔敏, 徐淼, 和秋莉, 等. 俯卧位通气对海水淹溺型急性呼吸窘迫综合征大鼠的治疗作用. 中国现代医生, 2021, 59(11): 26-29,35.
8.	程志鹏, 刘金霞, 苏程程, 等. 全氟化碳雾化吸入对大鼠海水吸入性肺损伤治疗作用研究. 解放军医学学报, 2023, 44(5): 508-513.
9.	仲崇翔, 廖日洪. 海水淹溺患者体内生化指标的变化分析. 临床医学, 2012, 32(9): 49-50.
10.	逄忠利, 梁军涛, 赵永茂, 等. 海水淹溺患者心电图变化及影响因素. 中国疗养医学, 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. 槲皮素通过抑制肺巨噬细胞的 M1 极化减轻海水吸入诱导的小鼠急性肺损伤. 细胞与分子免疫学杂志, 2017, 33(6): 751-755.
18.	万斌斌, 刘钢, 袁佳宁, 等. 血红素加氧酶-1 抑制 M1 巨噬细胞极化对海水淹溺性肺损伤小鼠的保护作用. 中华航海医学与高气压医学杂志, 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.	张春阳, 田光. 淹溺与肺损伤及其治疗. 中国临床医生杂志, 2016, 44(1): 10-12.
25.	高习文, 修清玉, 孙波, 等. 海水淹溺肺水肿大鼠肺表面活性物质磷脂的变化. 第二军医大学学报, 2005(8): 903-906.
26.	王瑛, 姚晓光, 李南方, 等. 肺泡表面活性物质特点及功能研究进展. 医学研究杂志, 2019, 48(11): 180-183.
27.	李毅, 邹日坤, 蒋富强, 等. 大剂量氨溴索对海水浸泡致急性肺损伤犬体内SP-A、SP-B含量的影响. 海南医学院学报, 2014, 20(8): 1038-1040.
28.	王小川, 杜发旺, 姚宇, 等. 西格列汀通过上调TTF-1/SP-B通路对LPS诱导小鼠急性肺损伤的保护作用. 西南医科大学学报, 2023, 46(6): 495-499.
29.	乔永平, 刘轶宁. IL-8 及 SPB 蛋白在兔海水及淡水淹溺型急性肺损伤模型中的表达. 临床肺科杂志, 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, 温媛婷, 等. 小剂量肝素对小鼠淹溺肺损伤 SOD、MPO 活性和 MDA 水平的影响. 中国应用生理学杂志, 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.	段锐, 金发光. TGF-β1/Smad2 信号通路参与海水淹溺肺损伤引起的细胞凋亡. 中华肺部疾病杂志(电子版), 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.	韩志海, 段蕴铀, 刘于红, 等. 控制性肺膨胀治疗海水淹溺肺损伤兔的实验研究. 中国急救医学, 2007, 27(5): 440-442,482.
38.	王飞, 张文祥. 淡水淹溺重症患者的机械通气策略及预防. 疾病监测与控制, 2013, 7(12): 730-732.
39.	王颖, 唐志华. 高压氧综合治疗海水淹溺性肺水肿 20 例疗效观察. 中华航海医学与高气压医学杂志, 2020, 27(1): 107-109.
40.	Şık N, Şenol HB, Çağlar A, et al. Early application of non-invasive ventilation for children with pulmonary edema after drowning. Pediatr Int, 2022, 64(1): e14858.
41.	张兵华, 费晋秀, 赵亚玲, 等. 不同剂量地塞米松对兔海水淹溺性肺水肿血清氧自由基的影响. 中国现代医学杂志, 2011, 21(20): 2338-2342.
42.	孙玉红. 甲强龙在海水溺水致急性肺水肿院前急救中的效果观察. 中国实用医药, 2022, 17(6): 149-151.
43.	韩璐瑶, 高永恒, 鱼高乐, 等. 地塞米松联合肌肽在海水淹溺性肺损伤中的治疗作用. 中华结核和呼吸杂志, 2020, 43(9): 772-777.
44.	谢晓燕, 王永兴, 敬梅, 等. 丹参酮ⅡA 磺酸钠对海水淹溺性肺水肿大鼠的作用及其机制. 中华航海医学与高气压医学杂志, 2013, 20(2): 86-90.
45.	田冶, 葛帅娜, 李军, 等. 人参皂苷 Rg1 对大鼠海水淹溺性肺损伤的保护作用及其机制. 武警医学, 2022, 33(2): 140-143.
46.	黄艳生, 文文, 赖国祥, 等. 白藜芦醇对海水淹溺性肺损伤大鼠的保护作用研究. 中国呼吸与危重监护杂志, 2021, 20(8): 570-576.
47.	王欢, 王丽娜, 顾伟. 参附注射液对低温水浴浸泡小鼠肺损伤及生化指标的影响. 海军医学杂志, 2020, 41(3): 278-282.
48.	Zhang L, Kong D, Huang J, et al. The Therapeutic effect and the possible mechanism of C-phycocyanin in lipopolysaccharide and seawater-induced acute lung injury. Drug Des Devel Ther, 2022, 16: 1025-1040.
49.	Li C, Bo L, Li P, et al. Losartan, a selective antagonist of AT1 receptor, attenuates seawater inhalation induced lung injury via modulating JAK2/STATs and apoptosis in rat. Pulm Pharmacol Ther, 2017, 45: 69-79.
50.	Bierens J, Abelairas-Gomez C, Barcala Furelos R, et al. Resuscitation and emergency care in drowning: a scoping review. Resuscitation, 2021, 162: 205-217.

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. 冯庆国, 安友仲, 魏凯, 等. 等量淡水淹溺与海水淹溺对绵羊肺循环血流动力学及呼吸力学影响的随机对照研究. 中华危重病急救医学, 2020, 32(2): 177-182.
4. 钟旺旺, 魏梁锋, 陈伟强, 等. 大鼠创伤性脑损伤合并海水淹溺性急性肺损伤模型的建立. 中华航海医学与高气压医学杂志, 2019, 26(4): 267-271.
5. 董文度, 赵增荣, 张敏华, 等. 兔海水淹溺肺水肿时肺损伤及其机理研究. 中华航海医学杂志, 1998, 5(1): 16-19.
6. 张春阳, 李亮, 张宁坤, 等. 气管植入间充质干细胞联合部分液体通气对海水淹溺致肺损伤大鼠治疗作用的研究. 临床肺科杂志, 2021, 26(11): 1680-1685.
7. 孔敏, 徐淼, 和秋莉, 等. 俯卧位通气对海水淹溺型急性呼吸窘迫综合征大鼠的治疗作用. 中国现代医生, 2021, 59(11): 26-29,35.
8. 程志鹏, 刘金霞, 苏程程, 等. 全氟化碳雾化吸入对大鼠海水吸入性肺损伤治疗作用研究. 解放军医学学报, 2023, 44(5): 508-513.
9. 仲崇翔, 廖日洪. 海水淹溺患者体内生化指标的变化分析. 临床医学, 2012, 32(9): 49-50.
10. 逄忠利, 梁军涛, 赵永茂, 等. 海水淹溺患者心电图变化及影响因素. 中国疗养医学, 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. 槲皮素通过抑制肺巨噬细胞的 M1 极化减轻海水吸入诱导的小鼠急性肺损伤. 细胞与分子免疫学杂志, 2017, 33(6): 751-755.
18. 万斌斌, 刘钢, 袁佳宁, 等. 血红素加氧酶-1 抑制 M1 巨噬细胞极化对海水淹溺性肺损伤小鼠的保护作用. 中华航海医学与高气压医学杂志, 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. 张春阳, 田光. 淹溺与肺损伤及其治疗. 中国临床医生杂志, 2016, 44(1): 10-12.
25. 高习文, 修清玉, 孙波, 等. 海水淹溺肺水肿大鼠肺表面活性物质磷脂的变化. 第二军医大学学报, 2005(8): 903-906.
26. 王瑛, 姚晓光, 李南方, 等. 肺泡表面活性物质特点及功能研究进展. 医学研究杂志, 2019, 48(11): 180-183.
27. 李毅, 邹日坤, 蒋富强, 等. 大剂量氨溴索对海水浸泡致急性肺损伤犬体内SP-A、SP-B含量的影响. 海南医学院学报, 2014, 20(8): 1038-1040.
28. 王小川, 杜发旺, 姚宇, 等. 西格列汀通过上调TTF-1/SP-B通路对LPS诱导小鼠急性肺损伤的保护作用. 西南医科大学学报, 2023, 46(6): 495-499.
29. 乔永平, 刘轶宁. IL-8 及 SPB 蛋白在兔海水及淡水淹溺型急性肺损伤模型中的表达. 临床肺科杂志, 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, 温媛婷, 等. 小剂量肝素对小鼠淹溺肺损伤 SOD、MPO 活性和 MDA 水平的影响. 中国应用生理学杂志, 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. 段锐, 金发光. TGF-β1/Smad2 信号通路参与海水淹溺肺损伤引起的细胞凋亡. 中华肺部疾病杂志(电子版), 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. 韩志海, 段蕴铀, 刘于红, 等. 控制性肺膨胀治疗海水淹溺肺损伤兔的实验研究. 中国急救医学, 2007, 27(5): 440-442,482.
38. 王飞, 张文祥. 淡水淹溺重症患者的机械通气策略及预防. 疾病监测与控制, 2013, 7(12): 730-732.
39. 王颖, 唐志华. 高压氧综合治疗海水淹溺性肺水肿 20 例疗效观察. 中华航海医学与高气压医学杂志, 2020, 27(1): 107-109.
40. Şık N, Şenol HB, Çağlar A, et al. Early application of non-invasive ventilation for children with pulmonary edema after drowning. Pediatr Int, 2022, 64(1): e14858.
41. 张兵华, 费晋秀, 赵亚玲, 等. 不同剂量地塞米松对兔海水淹溺性肺水肿血清氧自由基的影响. 中国现代医学杂志, 2011, 21(20): 2338-2342.
42. 孙玉红. 甲强龙在海水溺水致急性肺水肿院前急救中的效果观察. 中国实用医药, 2022, 17(6): 149-151.
43. 韩璐瑶, 高永恒, 鱼高乐, 等. 地塞米松联合肌肽在海水淹溺性肺损伤中的治疗作用. 中华结核和呼吸杂志, 2020, 43(9): 772-777.
44. 谢晓燕, 王永兴, 敬梅, 等. 丹参酮ⅡA 磺酸钠对海水淹溺性肺水肿大鼠的作用及其机制. 中华航海医学与高气压医学杂志, 2013, 20(2): 86-90.
45. 田冶, 葛帅娜, 李军, 等. 人参皂苷 Rg1 对大鼠海水淹溺性肺损伤的保护作用及其机制. 武警医学, 2022, 33(2): 140-143.
46. 黄艳生, 文文, 赖国祥, 等. 白藜芦醇对海水淹溺性肺损伤大鼠的保护作用研究. 中国呼吸与危重监护杂志, 2021, 20(8): 570-576.
47. 王欢, 王丽娜, 顾伟. 参附注射液对低温水浴浸泡小鼠肺损伤及生化指标的影响. 海军医学杂志, 2020, 41(3): 278-282.
48. Zhang L, Kong D, Huang J, et al. The Therapeutic effect and the possible mechanism of C-phycocyanin in lipopolysaccharide and seawater-induced acute lung injury. Drug Des Devel Ther, 2022, 16: 1025-1040.
49. Li C, Bo L, Li P, et al. Losartan, a selective antagonist of AT1 receptor, attenuates seawater inhalation induced lung injury via modulating JAK2/STATs and apoptosis in rat. Pulm Pharmacol Ther, 2017, 45: 69-79.
50. Bierens J, Abelairas-Gomez C, Barcala Furelos R, et al. Resuscitation and emergency care in drowning: a scoping review. Resuscitation, 2021, 162: 205-217.

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West China Medical Journal

Research progress on pathogenic mechanism and treatment strategy of seawater induced acute lung injury

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