脓毒症、介质与多系统器官衰竭──临床与实验研究的启示  

Sepsis,mediator and multiple organ failure

作　　者：徐世豪[1] 盛志勇[1] 

机构地区：[1]解放军第304医院

出　　处：《中国危重病急救医学》1995年第6期365-368,共4页Chinese Critical Care Medicine

摘　　要：多系统器官功能衰竭（ＭＳＯＦ）的概念及诊断至今仍存在混乱，此命名并不能正确的反映其本质，也不能与其它临床情况如老年性及濒死的器官衰竭等明确的区分开来。应用顺磁共振技术通过对烧伤患者及烧伤鼠模型研究结果，表明存在由于各种组织细胞膜的脂质过氧化而致氧自由基过度产生，小肠似对低灌流－再灌注损伤特别敏感；回肠二胺氧化酶活性降低及菌群迁移的产生，表明肠粘膜屏障功能衰竭。同时血浆内毒素（ＬＰＳ）及肿瘤坏死因子（ＴＮＦ－α）水平亦均显著升高。在最后发展为ＭＳＯＦ的患者尤为显著。本研究表明由肠道而来的细菌和（或）内毒素加重了由缺血－再灌注损伤及大量坏死组织所致的全身反应。作者认为目前对的ＳＯＦ的诊断标准不能导致早期诊断，它只能反映其病理生理发展过程的终点；而我们的治疗战略应直接针对不同水平的启动因子、全身介质及损伤的效应器。故应特别强调脓毒反应在ＭＳＯＦ综合征发展过程中的重要性。故建议将此综合征改名为“脓毒症伴器官功能不全”或“多器官介质损伤”。There are still controversies concerning theconceptand diagnosis of multiple system organ failure(MSOF),since the term does not precisely define its true nature,and its differential diagnosis with other irrelevant clinicalconditions, such as senile dysfunction of organs, agonalstate, remains unclarmed.Our studies on both humanburn patients and rat model by means of electron spinresonance(ESR)showed that there was an excessivegeneration of free oxygen radicals resulting in lipid per-oxidation of cell membrane of various tissues.The intes-tine seemed to be particularly sensitive to hypoperfusion-reperfusion injury , as diamine oxidase activity of theileum was lowered and translocation ofbacteria oc-curred , indicating the failure of barrier function of in-testinal mocosa. Concomitant determinations of plasmaendotoxin(LPS)and tumor necrosis factor alpha(TN-Fa)levels showed significant elevation , especially in pa-tients who finally deveIoped MSOF. The data suggestedthat intestinally derived bacteria and/or LPS exacerbatedthe systemic responses initiated by ischemic reperfusioninjury and the presence of large amount of devitalizedtissue. Early diagnosis is important in order to improvethe prognosis. However , current criteria of diagnosis forMSOF do not conduce to an early diagnosis,as they onlydescribe the end stage manifestations, while our thera-peutic strategy should be directed against different levelsof initiators, systemic mediators, and effectors of injury. Therefore, it is important to emphasize the role of septicresponses in the development of the syndrome, We pro-pose that the name of the syndrome be changed to “sep-sis with organ dysfunction”, or“ mediator injury oforgans”.

关 键 词：脓毒症 介质 多器官衰竭 

分 类 号：R631.102[医药卫生—外科学] R590.2[医药卫生—临床医学]