Sepsis is a systemic reaction syndrome caused by various infectious factors,and its core mechanism is immue disorder. Macrophages, known as the most important component of innate immunity, play an important role in the occurrence and development of sepsis. Macrophage polarization has been shown to be closely related to inflammation and immunity. In the occurrence and development of sepsis,the mechanisms are complex and unclearly. The release of inflammatory factors and the occurrence of inflammatory responses will be regulated by changes in macrophage polarization phenotype. Multiple signaling pathways such as Toll-like receptor 4/nuclear transcription factor-κB (TLR4/NF-κB), phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt), Janus kinase/signal transduction and transcription activator (JAK/STAT), adenosine-activated protein kinase-peroxisome proliferation-activated receptor γ (AMPK-PPARγ), Notch, C-Jun amino terminal kinase (JNK), nuclear factor E2-related factor 2 (Nrf2), etc. are involved in the regulation of macrophage polarization,and interact with each other.Regulation of macrophage polarization will be a new target for the prevention and treatment of the occurrence, development and prognosis of sepsis. This paper summarized the latest progress of macrophage polarization phenotype in the occurrence and development of sepsis, aiming to provide new ideas and methods for clinical prevention and treatment of sepsis.