Gut-origin sepsis: evolution of a concept.
Gut-origin sepsis: evolution of a concept.
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DOI：
10.1016/j.surge.2012.03.003
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发表时间：
2012-12
影响因子：
2.5
通讯作者：
Deitch, Edwin A.
中科院分区：
文献类型：
--
作者：
Deitch, Edwin A.
在过去的几十年里，细菌移位和肠源性败血症作为外科和ICU患者全身感染并发症和多器官功能障碍综合征（MODS）的原因的概念已经出现，尽管这些现象的确切临床相关性仍存在争议。因此，本综述的目的是追踪肠源性脓毒症和肠诱导的MODS的演变，并将这些疾病和观察结果纳入临床观点。此外，将探讨导致肠源性并发症的机制以及限制或预防这些并发症的治疗方案。从这项工作中，出现了几个主要结论。首先，细菌移位发生在临床上，是导致接受腹部大手术的患者感染并发症增加的原因。然而，细菌移位现象不足以解释ICU患者MODS的发生。相反，这些高危患者中MODS的发展可能是由于肠道损伤和非微生物的全身性传播，组织损伤因子通过肠道消化道到达体循环。这些观察结果导致了MODS的肠淋巴假说。
The concept of bacterial translocation and gut-origin sepsis as a cause of systemic infectious complications and the multiple organ dysfunction syndrome (MODS) in surgical and ICU patients has emerged over the last several decades, although the exact clinical relevance of these phenomenon continue to be debated. Thus, the goal of this review will be to trace the evolution of gut-origin sepsis and gut-induced MODS and put these disorders and observations into clinical perspective. Additionally, the mechanisms leading to gut-derived complications will be explored as well as therapeutic options to limit or prevent these complications. From this work, several major conclusions emerge. First, that bacterial translocation occurs clinically and is responsible for increased infectious complications in patients undergoing major abdominal surgery. However, the phenomenon of bacterial translocation is not sufficient to explain the development of MODS in ICU patients. Instead, the development of MODS in these high risk patients is likely due to gut injury and the systemic spread of non-microbial, tissue injurious factors that reach the systemic circulation via the intestinal lymphatics. These observations have resulted in the gut lymph hypothesis of MODS.
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