Evidence for early supply independent mitochondrial dysfunction in patients developing multiple organ failure after trauma
Evidence for early supply independent mitochondrial dysfunction in patients developing multiple organ failure after trauma
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DOI：
10.1097/00005373-199703000-00023
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发表时间：
1997-03-01
影响因子：
--
通讯作者：
Moore, EE
中科院分区：
文献类型：
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作者：
Cairns, CB;Moore, FA;Moore, EE
目的：为了确定在发生多器官衰竭（MOF）的创伤患者中是否发生早期供应非依赖性线粒体氧化功能障碍，设计：前瞻性聚焦观察性试验，方法：高危患者积极复苏，同时通过近红外光谱连续监测，近红外光谱监测条允许直接比较组织氧合血红蛋白水平（HbO（2））的变化，在正常情况下，HbO（2）和a，a（3）氧化还原紧密耦合，另一方面，HbO（2）和a，a（3）氧化还原解耦是线粒体氧化功能障碍的标志，结果包括MOF、氧输送、氧消耗、乳酸，以及HbO（2）和a，a（3）氧化还原反应的存在。结果：24例高危患者进行了研究;在复苏12小时时，MOF和非MOF患者的氧输送和氧消耗没有统计学差异，但MOF患者的乳酸水平显著更高。此外，（3）8例（89%）MOF患者与2例（13%）非MOB患者相比，氧化还原反应发生解耦（p <0.05）。结论：严重创伤患者发生MOF后，尽管早期以最大化氧供为目标，但在复苏过程中更倾向于早期显示线粒体氧化功能障碍的证据。
Objective: To determine whether early supply independent mitochondrial oxidative dysfunction occurs in trauma patients who develop multiple organ failure (MOF),Design: Prospective focused observational trial,Methods: High-risk patients were aggressively resuscitated while being continuously monitored by near infrared spectroscopy, Near infrared spectroscopy monitoring strips allow for a direct comparison of changes in tissue oxyhemoglobin levels (HbO(2)), which reflect local oxygen supply, and cytochrome a,a(3) redox, which reflects mitochondrial oxygen consumption, Under normal conditions, HbO(2) and a,a(3) redox are tightly coupled, On the other hand, decoupled HbO(2) and a,a(3) redox is a sign of mitochondrial oxidative dysfunction, Outcomes included MOF, oxygen delivery, oxygen consumption, lactate, and the presence of decoupled HbO(2) and a,a(3) redox,Results: Twenty-four high-risk patients were studied; nine (38%) developed MOF, At 12 hours of resuscitation, MOF and non-MOF patients did not have statistically different oxygen delivery and oxygen consumption, but lactate levels were significantly higher in MOF patients, Additionally, HBO2 and a,a(3) redox were decoupled in eight (89%) MOF patients compared with two (13%) non-MOB patients (p < 0.05),Conclusion: Severely injured trauma patients who develop MOF preferentially display evidence of mitochondrial oxidative dysfunction early in the course of their resuscitation despite early goal-oriented maximization of oxygen delivery.