A STUDY FROM THE CELLULAR ASPECT ON THE PATHOPHYSIOLOGY AND TREATMENT OF MULTIPLE ORGAN FAILURE

多器官功能衰竭（multiple organ failure，MOF）是重要器官细胞损伤的总和。因此，应考虑通过改善重要器官的细胞功能障碍来治疗MOF。对于这种方法，能够表达细胞损伤严重程度的参数是必不可少的。我们提出的细胞损伤评分（cellular injury score，CIS）是根据动脉血酮体比率（AKBR）、血清渗透压差（osmolality gap）和血乳酸（blood lactate）三种不同的细胞代谢序列计算的，是一个很好的评价多器官功能衰竭患者病情严重程度的指标。脓毒症、创伤和休克等多种损伤后细胞功能的损害可通过两种机制引起：组织氧代谢紊乱和体液介质。因此，治疗和/或预防危重病细胞损伤应通过改善组织氧代谢和对抗体液介质来实现。我们已经发现，连续性血液滤过（CHF）/连续性血液透析滤过（CHDF）可有效清除各种体液介质，并且这些连续性血液净化也可有效改善儿茶酚胺给药后的组织氧代谢。这些结果表明，改善细胞功能障碍是MOF的有效治疗/预防。

We have claimed that multiple organ failure (MOF) is the summation of the cellular injury in vital organs. Therefore therapeutic approaches to the MOF should be considered through the improvement of cellular dysfunction in the vital organs. For such approach the parameters which can express the severity of cellular injury is essential. The cellular injury score (CIS), which is derived from three different cellular metabolic sequences, arterial ketone body ratio (AKBR), serum osmolality gap and blood lactate and is proposed by us is found to be a good index to evaluate the severity of the patients with MOF. The impairment of cellular function following various insults such as sepsis, trauma, and shock can be caused through two mechanism: derangement in tissue oxygen metabolism and humoral mediators. Therefore for the treatment and/or prevention of cellular injury in the critically ill should be achieved through the improvement of tissue oxygen metabolism and the counter-measures for the humoral mediators. We have found that continuous hemofiltration (CHF)/continuous hemodiafiltration(CHDF) effectively remove the various humoral mediators and that those continuous blood purifications are also effective in the improvement of tissue oxygen metabolism following the administration of catecholamines. These results suggest that improvement of cellular dysfunction is an effective treatment/prophylaxis for MOF.