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

从细胞角度研究多器官衰竭的病理生理学和治疗

基本信息

批准号：
02454351
负责人：
HIRASAWA Hiroyuki
金额：
$ 4.29万
依托单位：
Chiba University School of Medicine Medical Center
依托单位国家：
日本
项目类别：
Grant-in-Aid for General Scientific Research (B)
财政年份：
1990
资助国家：
日本
起止时间：
1990 至 1992
项目状态：
已结题

项目摘要

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.

我们认为，多器官衰竭(MOF)是重要器官细胞损伤的总和。因此，治疗MOF的方法应该从改善重要器官的细胞功能障碍来考虑。对于这种方法，能够表示细胞损伤严重程度的参数是必不可少的。由动脉血酮体比(AKBR)、血清渗透压差(GAP)和血乳酸三种不同的细胞代谢序列得出的细胞损伤评分(CIS)被认为是评价MOF患者病情严重程度的良好指标。脓毒症、创伤和休克等各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，对于危重病人细胞损伤的治疗和/或预防，应通过改善组织氧代谢和体液介质的应对措施来实现。我们发现连续血液滤过(CHF)/连续血液透析滤过(CHDF)有效地去除了各种体液介质，这些连续血液净化也有效地改善了给药儿茶酚胺后的组织氧代谢。这些结果提示，改善细胞功能障碍是治疗/预防MOF的有效方法。