Oxygen is the most commonly used therapy in hospitalized patients with COVID-19. In those patients who develop worsening pneumonia and acute respiratory distress syndrome (ARDS), high concentrations of oxygen may need to be administered for prolonged time periods, often together with mechanical ventilation. Hyperoxia, although lifesaving and essential for maintaining adequate oxygenation in the short-term, may have adverse long-term consequences upon lung parenchymal structure and function. How hyperoxia per se impacts lung disease in COVID-19 has remained largely unexplored. Numbers of experimental studies have previously established that hyperoxia is associated with deleterious outcomes inclusive of: perturbations in immunologic responses; abnormal metabolic function and alterations in hemodynamics and alveolar barrier function. Such changes may ultimately progress into clinically evident lung injury, adverse remodeling and result in parenchymal fibrosis when exposure is prolonged. Given that significant exposure to hyperoxia in patients with severe COVID-19 may be unavoidable to preserve life, these sequelae of hyperoxia, superimposed on the cytopathic effects of SARS-CoV-2 virus may well impact pathogenesis of COVID-19-induced ARDS.

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高氧与COVID-19中肺血管和免疫反应的调节

氧气是住院的COVID-19患者最常用的疗法。在那些发生恶化的肺炎和急性呼吸窘迫综合征（ARDS）的患者中，可能需要长时间和机械通气一起服用高浓度的氧气。高氧血症虽然可以挽救生命，并且在短期内对于维持充足的氧气至关重要，但对肺实质结构和功能可能会产生长期的不利影响。高氧本身如何影响COVID-19中的肺部疾病，目前尚无定论。先前的许多实验研究已经确定，高氧与有害的结局有关，包括：免疫应答的扰动；异常的代谢功能以及血液动力学和肺泡屏障功能的改变。此类改变最终可能会发展为临床上明显的肺损伤，不良的重塑，并在长时间的暴露下导致实质性纤维化。鉴于重症COVID-19患者可能不可避免地需要大量暴露于高氧血症以维持生命，因此，这些高氧血症后遗症与SARS-CoV-2病毒的细胞病变作用叠加可能会很好地影响COVID-19诱导的ARDS的发病机理。