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.

     

肺脏在老龄大鼠多器官衰竭中的作用

目的：探讨肺脏在老龄大鼠多器官衰竭中的作用。方法：一次性静脉主射大肠杆菌内毒素，复制出老龄大鼠多器官衰竭（ＭＯＦ）实验模型。动态观察了五个时相组（１、２，６、１２，２４ｈ）的有关免疫，生化功能指标和病理变化。     

多器官功能衰竭中急性肾衰的腹透治疗

对１５例不适合作血透治疗的多脏器功能衰竭中的急性肾功能衰竭患者，于确立诊断后２４ｈ内立即行间歇性腹膜透析治疗。除３例因呼吸循环衰竭死亡外，１２例患者于半月内肾功能恢复或基本恢复。认为对不适合血液透析的多脏器衰竭中的急性肾功能衰竭患者，腹膜透析具有较好的效果。     

器官衰竭中白细胞凋亡的研究

目的 探讨细胞凋亡百分率与多系统器官衰竭(MOF)的预后关系.方法采用对照双盲法流式细胞仪检测MOF患者外周血淋巴细胞与单核粒细胞的凋亡早期、凋亡性死亡百分率.结果①MOF患者淋巴细胞、单核粒细胞凋亡早期和凋亡性死亡率高于对照组(P＜0.05);②MOF患者单核粒细胞凋亡性死亡百分率与器官衰竭数目成正相关;③单核粒细胞凋亡总百分率、器官衰竭数与MOF患者死亡成正相关.结论 MOF患者外周血单核粒细胞凋亡异常增加,并且与衰竭器官数目和死亡正相关.     

肿瘤坏死因子在急性胰腺炎及并发多器官衰竭中作用的研究

作者对３２例急性胰腺炎患者，血液中肿瘤坏死因子、氧自由基以及内毒素血症在急性胰腺炎病程发展中的作用进行了研究。结果表明ＴＮＦ和ＯＦＲ在急性胰腺炎患者中含量增高，并与临床症状的变化相一致。     

Changes of thromboxane and prostacyclin in the pathogenesis of multiple organ failure in severe burns

Fifty-seven severely burned patients were divided into 2 groups:16 withmultiple organ failure(MOF),and 41 without MOF.It was found that the levelof thromboxane B_2(TXB_2)and the ratio between TXB_2 and 6-keto-prostaglandinF_(1α)(TBX_2/6-keto-PGF_(1α))in plasma and in visceral tissues were increased and re-mained significantly high in the first 5～7 d postburn in patients with MOF but notso in those without MOF.The circulatory platelet aggregate ratio(CPAR)wasmarkedly decreased in the same period in MOF group.Myocardial enzymes(CPK,LDH,and GOT)were markedly increased in the first 3d and remainedsignificantly high within 7 d postburn.Degeneration,structural destruction,edema,hemorrhage and thrombosis were revealed in cardiac,pulmonary,renal andhepatic tissues succumbing to functional failure.Thirteen out of the 16 cases de-veloped MOF during the 3rd to 7th day posthurn and 11 died in that period.These findings substantiate that persistent increase of thromboxane andthromboxane/prostacyclin ratio is closely related to the origin and development ofMOF after burn injury.     

血色病多系统器官衰竭1例

1　病例报告　男 ,6 3岁 .因间断性乏力、纳差 30ｄ ,加重伴心慌、气短 2ｗｋ于 2 0 0 1 12 11入院 .1995年因胆石症行胆囊摘除术时发现脾肿大 ,并行脾切除术 .查体 :Ｔ 36 .4℃ ,Ｐ 6 8次·ｍｉｎ-1,Ｒ 2 8次·ｍｉｎ-1,ＢＰ 12 / 8ｋＰａ .神志清 ,精神差 ,皮肤巩膜轻度黄染 ,有肝掌无蜘蛛痣 ,口唇轻度发绀 ,颈静脉怒张 ,左下肺叩诊呈实音 ,触觉语颤减弱 ,呼吸音减低 ,双肺底均可闻及细小湿性罗音 .心界向左下扩大 ,心率 6 8次·ｍｉｎ-1,心律不齐 ,音低钝 ,Ｐ2分裂 ,胸骨左缘第 4、5肋间可闻及收缩期Ⅱ级吹风样杂音 .腹膨隆 ,无腹壁静脉…     

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.

     

重症哮喘并发器官功能衰竭的护理与观察

目的:研究哮喘患者并发器官功能衰竭的护理体会。方法:总结重症哮喘发生多器官功能衰竭(MOF)12例、单器官功能衰竭(OF)19例、双器官功能衰竭(DOF)12例的病因、临床表现、监护指标、护理观察等,探讨若干有待解决的问题。结果:重症哮喘易出现MOF、OF、DOF,主要原因为机体严重缺氧,引起微循环障碍及炎症介质等因素导致全身内循环紊乱。针对其发生器官功能衰竭的重症哮喘患者的护理工作,加强心理护理,消除紧张情绪,严密观察病情,及时沟通医生,防止并发症,是增加治愈率、降低死亡率的关键。结论:呼吸重症监护(RICU)在危重救治中发挥重要的作用。     

急性颈髓损伤并发多系统器官衰竭的临床分析

目的：探讨急性颈髓损伤并发多系统器官衰竭（ＭＳＯＦ）发病因素及其类型，为防治伤后ＭＳＯＦ提供依据。方法：对３０３例急性外伤性颈髓损伤并发ＭＳＯＦ的３２例患者进行回顾性分析。结果：颈髓损伤并发ＭＳＯＦ的诱因为肺部感染，高热，水电解质平衡紊乱，低蛋白血症，颈髓损伤患者ＭＳＯＦ的发生率为１０．５６％，ＭＳＯＦ患者的死亡率为７８．１３％（２５／３２），结论：消除ＭＳＯＦ的诱因及对可能发生或发生功能不全的器     

高龄多器官功能衰竭患者甲状腺功能的变化

1临床资料2003-10/2004-12住院老年多器官功能衰竭患者46例,全部为男性,年龄(79±5)岁.2个器官功能衰竭为A组15例,年龄(77±6)岁;3个以上器官功能衰竭为B组20例,年龄(79±7)岁;死亡为C组11例,年龄(78±4)岁;无重要脏器功能衰竭的老年患者20例为对照组,年龄(78±6)岁,全部为男性.以上受试对象均无甲状腺疾病病史,未用影响甲状腺功能的药物.清晨空腹安静状态下抽取静脉血2mL用放免法测定TT3,TT4,FT3,FT4及TSH,药盒由天津DPC公司提供.ABC3组TT3(nmol/L)和FT3(pmol/L)水平均减低,C组减低最明显,分别为1.7±0.4和3.9±0.9,1.3±0.4和…     

Clinical features of multiple organ failure in the elderly.

Multiple organ failure (MOF) in the elderly is a new syndrome evolved from multiple organ chronic diseases on the basis of multiple organ dysfunction in the aged. Its characteristics are clinically different from those of MOF due to serious trauma. 122 cases of MOF were analysed retrospectively and their clinical features discussed. MOF with a long course is the natural presentation in many of the elderly before death. Its main precipitating factors are pulmonary infection, metastatic carcinoma, cardiac attack, etc. The sequence of a failure in organs is heart, lung, kidney, liver, etc. The mortality is similar to that of MOF due to trauma. However, those suffering from 4-organ failure can still survive, and instead, the renal failure can be mostly fatal. More attention should be paid to the prevention of MOF in the elderly so as to shorten its developing course.

     

The relationship between organ perfusion pressure and multiple organ failure during mechanical left ventricular assist.

The purpose of this study was to analyze the relationship between hemodynamics, especially the organ perfusion pressure (OPP = mean aortic pressure-mean right atrial pressure) and multiple organ failure (MOF) in cardiac patients receiving left ventricular mechanical assists (LVA). The subjects were 33 patients who had undergone left ventricular mechanical assists in the Department of Cardiovascular Surgery, Fukushima Medical College Hospital, from March 1985 through March 1990. OPP significantly correlated with the levels of GOT, total-bililubin (TB), BUN and serum-creatinin (s-Cr), oxygenation index (OI) and respiratory index (RI). The cardiac index and left and right ventricular stroke work indices, in comparison with OPP, did not significantly correlate with any of the above laboratory tests. These results indicate that OPP is a simple and reliable index to recognize, and also to prevent MOF during LVA. It was also found that OPP should be maintained at a level higher than 65mmHg to protect the liver, kidneys and lungs.     

呼吸机相关肺炎合并老年多器官衰竭

目的：观察呼吸机相关肺炎（VAP）合并老年多器官衰竭（MOFE）患者的临床进展和特点，评价多器官功能不全评分系统（MOD评分）在预后判断中的临床价值。方法：前瞻性设计，研究了67例机械通气患者145次VAP发病，分析VAP患者并发MOFE的发生率，临床特点及治疗结果，评价MOD评分和预后的相关性。结果：134例次VAP发病进展并发MOFE（发生率为92．4％），其中34例死亡（病死率为25．4％），VAP患者发生MOFE的主要表现类型是单相型（I型）和双相型（Ⅱ型），Ⅱ型MOFE的病死率明显高于I型MOFE。VAP合并MOFE患者MOD评分为0－4、5－8、9－12和≥13分时的病死率分别为0、18．3％、45．9％和100％，VAP患者合并2、3、4和4个以上器官衰竭时的病死率分别为0、20．8％、56．5％和100％，各组间有显著的统计学意义。结论：VAP是MOFE的重要诱因，VAP并发MOFE患者的临床病程及治疗结果有其特点，MOD评分，衰竭器官数目和病死率之间呈明显的正相关，MOD评分在预后的判断中有一定的临床价值（临界值可设定为9分）。