Protective effect of Re-LPS antiserum on experimental multiple system organ failure.

This study examines the possible beneficial effect of Re-LPS (F515) antiserum on experimental multiple system organ failure (MSOF) in rabbits. The results showed that the plasma LPS level was significantly decreased, and it took a shorter period to clear up LPS in experimental than in control rabbits after receiving Re-LPS antiserum. Pretreatment with antiserum can markedly improve the function of the liver, lungs, kidneys, blood and gastrointestinal tract. The MSOF incidence in the group of rabbits receiving immune sera was only 11.2% and the survival rate was raised by about 40.0%. The results suggest that early passive immunotherapy may neutralize gut-derived endotoxin, inhibit endotoxin-induced mediators release and prevent development of severe complications due to sepsis. It is therefore postulated that LPS core antiserum may provide a prophylactic effect on the development of experimental MSOF.

     

内科病因急性肾功能衰竭合并多系统脏器衰竭

本文分析103例内科病因急性肾功能衰竭(ARF)的临床资料。结果表明,74％患者合并多系统脏器衰竭(MSOF)。MSOF的病死率高达41％;衰竭的脏器越多,病死率越高。然而,透析组的病死率和MSOF发生率均显著低于非透析组。作者认为,ARF诊断不及时和透析时机、方式选择不当是引起MSOF的原因之一。因此,早期诊断和早期预防性、充分透析对MSOF的防治是至关重要的。在透析疗法配合下,重视胃肠外营养疗法可望改善内科病因ARF的预后。此外,严重感染是导致MSOF的主要因素,应予积极防治。     

急性白血病并发多系统器官功能衰竭的危险因素

目的探讨急性白血病（ＡＬ）并发多系统器官功能衰竭（ＭＳＯＦ）的危险因素。方法通过对ＡＬ并发脏器衰竭的相关病死率、脏衰竭数目与相关病死率及各类型ＡＬ合并脏器衰竭病死率的分析，寻找ＡＬ合并ＭＳＯＦ的易患因素。结果ＡＬ合并ＭＳＯＦ３８例中，以中枢神经系统衰竭发生频度最高（４４％），衰竭器官的数目与病死率呈线性相关。ＡＬ合并ＭＯＳＦ存在一些易患因素。结论ＡＬ并发ＭＳＯＦ与高龄、原有严重器质性疾病、并发严重感染、显著的血液学异常及复发型ＡＬ有密切关系。     

婴幼儿重症肺炎与多器官功能衰竭

多器官功能衰竭(MSOF)是由Tilney在1973年提出的一个临床综合症,系指两个或两个以上器官同时或先后出现功能衰竭。其发病机理尚未阐明。目前,MSOF已是儿科急救医学的重要组成部份,是儿科急诊医师十分关注的课题。我们统计从1974年4月至1987年12月收治的婴幼儿肺炎4117例。对有多器官功能衰竭表现的421例进行     

80例多器官功能衰竭病人血清甲状腺激素的变化

总结80例多器官功能衰竭病人血清T_3、T_4及其中58例血清rT_3的变化。结果表明:多器官功能衰竭病人血清T_3、T_4降低,rT_3升高,与对照组比较,有显著差异,P<0.01。血清T_3、T_4下降与多器官功能衰竭病人病情危重程度及受损害器官多少有密切关系。肝功能衰竭患者低T_3、低T_4尤为严重,与对照组比较有非常显著差异,P<0.001,且与死亡率有明显关系。这提示血清T_3、T_4浓度可作为判断多器官功能衰竭病人预后的一项指标。     

多系统脏器衰竭患者血浆胃动素水平的初步研究

应用放射免疫分析法测定了３８例多系统脏器衰竭（ＭＳＯＦ）患者和４２例健康正常人血浆胃动素（ＭＴＬ）浓度。结果显示：①ＭＳＯＦ患者危重期血浆ＭＴＬ浓度较恢复期和正常对照组明显升高（Ｐ＜０．０１），而ＭＳＯＦ恢复期与正常对照组相比则无显著性差异（Ｐ＞０．０５）；②随着衰竭脏器的增多，ＭＴＬ浓度也随之增高（Ｐ＜０．０１）；③ＭＳＯＦ组中合并有中枢神经系统功能衰竭、胃肠功能衰竭、肝功能衰竭患者ＭＴＬ水平明显高于无合并上述系统脏器衰竭者，死亡组明显高于生存组（Ｐ＜０．０１）；④ＭＳＯＦ患者血浆ＭＴＬ水平与病情危重度评分吴正相关。本文对ＭＳＯＦ患者血浆ＭＴＬ水平增高的机理及临床意义作了初步深讨。     

重型颅脑损伤后多系统器官功能衰竭

目的与资料回顾１４例重型颅脑损伤后多系统器官功能衰竭患者的临床资料。进步１例，好转３例，中、重残各１例，死亡８例。结论该病病情复杂多变，预后恶劣，尽快恢复脑功能是防治该病的重要措施，包括及时恰当地采取颅脑手术在内的系统的综合性治疗。     

慢性肺心病并发多系统器官功能衰竭：附211例分析

多系统器官功能衰竭（MSOF）为一种新的综合征的概念被提出来，此综合征称为序贯性器官功能衰竭或序贯性多系统功能衰竭[1]。有人认为肺心病并发之多系统器官功能衰竭与本综合征是完全不同的两种概念[1]。但就其综合征目前所提出定义：“发病在24小时以上，有两个或两个以上器官或系统序贯性渐进性地发生功能衰竭”[1,2]。肺心病并发多系统器官功能衰竭仍应属于MSOF范畴。现将我院收治的肺心病211例报告分析如下：1.临床资料本组男90例，女121例，年龄43－87岁。早期肺心病而无系统器官衰竭者未归纳于本组病例中。本组病例中单系统器官…     

婴幼儿重症喘憋性肺炎并发多系统器官功能衰竭(附51例临床分析)

本文报道婴幼儿喘憋性肺炎并发MSOF51例,结果合并心力衰竭100％,呼吸衰竭64.7％,胃肠衰45.1％,脑衰16.3％,肾衰11.8％,凝血机制障碍7.8％,肝衰5.9％。MSOF均在严重喘憋基础上发生,提示本病通气障碍及换气障碍导致严重低氧血症与高碳酸血症、代谢性和呼吸性酸中毒是MSOF的重要原因,器官功能衰竭与预后有密切关系,器官衰竭数增多,病死率明显增高。指出本病应具有预见性、针对性,有效的控制肺部感染,改善通气及换气功能,吸氧,统筹兼顾支持脏器功能,改善肺微循环障碍为主的全身微循环障碍是防治重症喘憋性肺炎MSOF的关键。     

小儿急性特重型、重型颅脑损伤并发多系统器官功能衰竭——附106例临床分析

目的 本文总结了106例小儿急性特重型、重型颅脑损伤并发多系统器官功能衰竭(MSOF)的救治经验.方法 对我院二十年共收治的小儿特重型、重型颅脑损伤并发MSOF进行回顾性总结.结果 106例小儿特重型、重型颅脑损伤并发MSOF存活37例(存活率为34.90%),其中良好和中残33例(31.13%),重残4例(3.77%),合并MSOF死亡69例(病死率为65.10%).结论 颅脑损伤的程度与并发MSOF呈正比关系,积极去除病因,防治MSOF的发生发展是有效降低病死率、提高生存质量的重要手段.     

老年COPD呼吸衰竭并发多器官衰竭的临床观察

目的探讨老年慢性阻塞性肺疾病(COPD)并发多脏器功能损害(MSOF)的临床特点及预后。方法回顾性分析34例老年COPD并MSOF患者的临床资料。结果34例中仅合并慢性呼吸衰竭4例(11.8%),并发多脏器功能损害30例(88.2%)。经治疗后,仅合并呼吸衰竭者好转率100%;合并MOSF后预后差,病死率与受累器官成正比。结论老年COPD并发多脏器功能损害的发生率越高,病死率越高。     

Bacterial translocation and multiple system organ failure in bowel ischemia and reperfusion.

Portal circulation was reduced to 50-60% for one hour by partial occlusion of the superior mesenteric artery for the purpose of studying the relationship between reperfusion injury, bacterial translocation and multiple system organ failure. Forty dogs were divided randomly into four groups, and 1 x 10(10)/kg E. coli O111B4 were fed to each animal 12 hours before operation. Group I constituted the controls, in which sham operations were performed. The experimental procedure was completed in all the animals of the other three groups. Rubia yunnanensis, an anti-oxidant, was given to group III. Amikacin was given to group IV. The results showed that group II was characterized by bacteremia, hypoxemia, and hypotension as compared with group I. The levels of superoxide dismutase (SOD) in the whole blood were markedly lowered and malondialdehyde (MDA) values significantly elevated in group II after reperfusion compared with group I. Plasma levels of anaphylatoxin C5a and B2 (TXB2) were significantly raised in group II beginning with the reperfusion when compared with groups I, III and IV. Pathological changes in the intestine, liver and lung were remarkable only in group II, including acute necrosis of the intestinal mucosa, granulocyte infiltration, hemorrhage and edema of the lung, degenerative changes of myocardial and hepatic cells, and bacterial invasion of the blood, liver and lung. These results suggested that bowel ischemia and reperfusion may promote gut barrier failure and bacterial translocation, then contribute to the development to multiple system organ failure (MSOF) by allowing bacteria or endotoxin normally contained within the gut to reach the portal and systemic circulations where it fuels the septic process. Oxygen free radicals, anaphylatoxin and thromboxane may be potential factors in the development of gut barrier failure and MSOF.

     

tudy on Diagnosis and Treatment of Infectious Multiple Organ Dysfunction Syndrome by Integrated Traditional Chinese and Western Medicine

Objective: To explore the diagnostic and therapeutic approach of integrated traditional Chinese and western medicine (TCM-WM) on infectious multiple organs dysfunction syndrome/multiple system and organ failure (MODS/MSOF) for elevating the successful rate of rescuing the patients. Methods: Diagnosis with western medicine and Syndrome Differentiation of TCM in 225 in-patients of acute infectious disease complicated with MODS/MSOF were conducted, and TCM treatment, based on western medical comprehensive treatment, was given to observe the effect and explore the mechanism of the TCM-WM therapy. Results: Up to the end of 1998, 161 cases of the 225 cases were successfully cured and 64 died, the mortality being 28.4%. Among them, 58 out of 140 cases of MSOF died, the mortality was accounted for 41.4%. In 106 cases conformed to the diagnostic criteria of MSOF proposed by Professor Knaus WA, USA, 52 cases were cured successfully and 54 died, the mortality being 50.94%. Conclusion:TCM-WM treatment could elevate the therapeutic effect in treating MODS, the mechanism might be through improving the hemodynamic and hemorrheologic condition of patients to relieve nail-fold microcirculation disorder; influencing the levels of cytokine and inflammatory mediator, so as to alleviate the systemic inflammatory reaction, it might also abate the inhibited condition of gastro-intestinal motility, alleviate the intestinal flora imbalance, prevent intestinal bacteria and endotoxin malposition, and protect cells from peroxidation.     

肺心病急发期并发多脏器功能损害与预后因素探讨

我院1985年1月至1989年10月收治的378例次肺心病急发期合并多脏器功能损害(Msof)156例41.2％,死亡53例(34.0％)。其中单脏器损害最多是肺脑91例(58.3％),病死率最高是DIC,5例均死亡,其次是上消化道出血死亡21例(72.4％)、循环衰竭死亡11例(57.8％)。本文提示:肺部感染、严重低氧血症、CO_2潴留为发病基础,同时,对并发MSOF的发病机理,影响预后的因素进行了讨论,井提出了降低病死率的几个关键性问题。     

妊高征合并MSOF综合征7例分析

目的探讨妊高征合并多器官功能衰竭临床处理的指导意义。方法通过对7例妊高征合并MSOF的诊断。治疗，分娩处理方式及胎儿合并症，新生儿存活等进行回顾性分析。结果衰竭器官的数目与死亡率呈正相关性。结论衰竭器官越多，死亡率越高。一个器官的衰竭可以影响其他系统和器官的功能。     

血液透析对急性肾衰并发症及病死率的影响

目的：探讨血透与非透析疗法对急性肾衰（ＡＲＦ）并发症及病死率的影响，分析主要死因变化。方法：对９９例ＡＲＦ患者，分血透（ＨＤ）组（５０例）与非透析（ＮＤ）组（４９例）进行回顾研究。分析并发症与病死率的关系及直接死因。结果：病死率：ＮＤ组４６．９％，ＨＤ组２０．０％（Ｐ＜０．０１）。并发症：心衰、心律紊乱、中枢神经系统病变，ＨＤ组明显低于ＮＤ组；感染、多脏衰（ＭＳＯＦ）和消化道出血无统计学意义。主要死因：ＮＤ组依次为ＭＳＯＦ、心衰及心律紊乱；ＨＤ组感染居第１，ＭＳＯＦ次之。结论：血液透析通过有效地防治心衰、心律紊乱及中枢神经系统并发症而降低ＡＲＦ的病死率，但不能降低ＡＲＦ感染发生率，感染为ＡＲＦ患者最主要的并发症和首位死因。     

休克型肺炎与多脏器损害临床分析

本文分析成人休克型肺炎59例的多脏器损害表现,初步探讨了本病多系统器官受损或衰竭的发病与预后的关系。本组55岁以上者占40.7%,发生中、重度休克有37例占62.7%,发生叶、段性肺炎有43例占76.8%;总的发生多脏器损害有43例占72.9%,除肺受损外,心血管、脑、肾受损较多。本组总病死率为14%,累及四个器官病死率为70%,五个器官为100%。本文最后提出休克型肺炎的治疗措施和早期检查各脏器功能的必要性。     

Study on Diagnosis and Treatment of Infectious Multiple Organ Dysfunction Syndrome by Integrated Traditional Chinese and Western Medicine

Ｏｂｊｅｃｔｉｖｅ：ＴｏｅｘｐｌｏｒｅｔｈｅｄｉａｇｎｏｓｔｉｃａｎｄｔｈｅｒａｐｅｕｔｉｃａｐｐｒｏａｃｈｏｆｉｎｔｅｇｒａｔｅｄｔｒａｄｉｔｉｏｎａｌＣｈｉｎｅｓｅａｎｄｗｅｓｔｅｒｎｍｅｄｉｃｉｎｅ（ＴＣＭ ＷＭ）ｏｎｉｎｆｅｃｔｉｏｕｓｍｕｌｔｉｐｌｅｏｒｇａｎｓｄｙｓｆｕｎｃｔｉｏｎｓｙｎ ｄｒｏｍｅ ｍｕｌｔｉｐｌｅｓｙｓｔｅｍａｎｄｏｒｇａｎｆａｉｌｕｒｅ（ＭＯＤＳ ＭＳＯＦ）ｆｏｒｅｌｅｖａｔｉｎｇｔｈｅｓｕｃｃｅｓｓｆｕｌｒａｔｅｏｆｒｅｓｃｕｉｎｇｔｈｅｐａｔｉｅｎｔｓ．Ｍｅｔｈ…     

Valproic acid attenuates the multiple-organ dysfunction in a rat model of septic shock

Background Valproic acid （VPA） improves early survival and organ function in a highly lethal poly-trauma and hemorrhagic shock model or other severe insults. We assessed whether VPA could improve organ function in a rat model of septic shock and illustrated the possible mechanisms. Methods Forty Sprague-Dawley rats were randomly assigned to four groups （n=-10）： control group, VPA group, LPS group, and LPS＋VPA group. Lipopolysaccharide （LPS） （10 mg/kg） was injected intravenously to replicate the experimental model of septic shock. Rats were treated with VPA （300 mg/kg, i.v.） or saline. Six hours after LPS injection, blood was sampled for gas analysis, measurement of serum alanine aminotransferase, aspartate aminotransferase, urine nitrogen, creatinine and tumor necrosis factor-alpha. Lung, liver and kidney were collected for histopathological assessment. In addition, myeloperoxidase activity and tumor necrosis factor-α in pulmonary tissue were measured. Acetylation of histone H3 in lung was also evaluated by Western blotting. Results LPS resulted in a significant decrease in PaO2, which was increased by VPA administration followed LPS injection. In addition, LPS also induced an increase in the serum levels of alanine aminotransferase, aspartate aminotransferase, urine nitrogen, creatinine, and tumor necrosis factor-alpha. However, these increases were attenuated in the LPS＋VPA group. The lungs, liver and kidneys from the LPS group were significantly damaged compared with the control group. However, the damage was attenuated in the LPS＋VPA group. Myeloperoxidase activity and tumor necrosis factor-alpha levels in pulmonary tissue increased significantly in the LPS group compared with the control group. These increases were significantly inhibited in the LPS＋VPA group. Acetylation of histone H3 in lung tissue in the LPS group was inhibited compared with the control. However, the level of acetylation of histone H3 in the LPS＋VPA group was markedly elevated in contrast to the LPS group. Conclusions Treatment with VPA can attenuate multiple organ damage caused by LPS induced septic shock. Our data also suggest that the beneficial effects are in part due to the decrease in inflammatory cytokines and restoration of normal acetylation homeostasis.     

高危前列腺增生症经尿道电切术临床观察

目的：探讨TuRP治疗高危BPH的安全性和有效性。方法：对30例高危BPH患者行TURP治疗,术后均随访,时间为3～10个月。结果：1例术后因多器官系统衰竭死亡。余术后恢复正常,排尿明显改善：TURP前后前列腺国际症状评分降低和最大尿流率增大,差异均有统计学意义（P〈0．05）。结论：经尿道电切术治疗高危BPH损伤小,安全性高,疗效确切且并发症少,适用于高危前列腺患者。