Hypermetabolism, organ failure, and metabolic support.
Hypermetabolism, organ failure, and metabolic support.
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代谢亢进、器官衰竭和代谢支持。
DOI：
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发表时间：
1987
期刊：
影响因子：
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通讯作者：
Cerra Fb
中科院分区：
文献类型：
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作者：
Cerra Fb
摘要 代谢亢进性器官衰竭综合征仍然是外科重症监护病房长期住院和死亡的主要原因。以前被认为是孤立的器官衰竭，例如成人呼吸窘迫综合征，现在被视为对损伤和修复的全身反应的一部分。脓毒症已成为由于微生物入侵而引起的全身炎症反应。曾经被认为是脓毒症的诊断方法在严重的灌注不足和持续存在死亡和受伤组织的情况下得到了认可。向器官衰竭的转变通常是一个独特的临床事件，并且可能代表临床肝衰竭的发生。一旦出现器官衰竭综合征，死亡率就会很高。从治疗的角度来看，人们认识到可能没有“灵丹妙药”；该治疗方案可能具有时间依赖性并且是“多种药物”；最好的治疗方法是预防。与疾病过程导致的身体成分变化相反，营养不良已成为持续代谢亢进和器官衰竭患者发病和死亡的公认辅助因素。代谢亢进的代谢过程已被越来越多地分类和理解。其结果是开发了与营养支持不同的代谢支持原则，旨在防止营养不良的终末器官变化和底物限制代谢的发展，支持器官结构和功能，并试图阻止代谢过程。最初的问题是学会不造成伤害，这是合理实现的结果。此外，一些有益的结果也得到了认可，包括更好地支持全身蛋白质合成、肝蛋白质合成和能量生产的新技术。正在测试更好地支持器官结构和功能的技术。目前还没有技术可以控制蛋白质水解和骨骼肌氮的重新分配。该领域仍处于起步阶段，仍需要进行大量研究。
Abstract The hypermetabolism organ failure complex remains the predominant reason for both prolonged stay and death in the surgical intensive care unit. What was perceived as isolated organ failure, such as adult respiratory distress syndrome, is now seen as part of the systemic response to injury and repair. Sepsis has become the systemic inflammatory response due to invading microorganisms. What was once perceived as diagnostic of sepsis has been recognized after severe perfusion deficits and in the presence of continuing sources of dead and injured tissue. The transition to organ failure is usually a distinct clinical event and probably represents the onset of clinical hepatic failure. Once present, the organ failure syndrome has a high mortality rate. From a treatment perspective, it is recognized that there is probably no "magic bullet"; that regimens will probably be time dependent and "multiple drug"; and that the best treatment is prevention. Malnutrition, as opposed to changes in body composition that occur as a result of disease process, has become a recognized cofactor in morbidity and death in patients with persistent hypermetabolism and organ failure. The metabolic processes of hypermetabolism have become increasingly categorized and understood. The result has been the development of metabolic support principles that are distinct from those of nutritional support and are designed to prevent the end-organ changes of malnutrition and the development of substrate-limited metabolism, to support organ structure and function, and to attempt to arrest the metabolic processes. The initial problem was to learn to do no harm, an outcome reasonably achieved. In addition, several beneficial results have been recognized including new techniques to better support total body protein synthesis, hepatic protein synthesis, and energy production. Techniques to better support organ structure and function are being tested. No techniques are currently available to control proteolysis and the redistribution of skeletal muscle nitrogen. A great deal of research is still necessary in this field, which is still in its infancy.