Pathophysiological Findings and Management of Multiple Organ Failure Complicating Massive Organ Resections

术后多器官功能衰竭是进行性的，预后较差。本研究旨在阐明MOF的发生机制和病理生理，寻求更好的治疗MOF的方法。通过八所研究所的合作研究，获得了以下结果：1. DIC与MOF: DIC是影响MOF最重要的因素之一，常与累及多个器官的病理紊乱程度并行发展。2. 呼吸和循环衰竭和MOF：血栓素<A_2>被认为是呼吸和心力衰竭的中介。补体介导的中性粒细胞积聚是导致呼吸衰竭的原因之一。3. 食管切除术后肺功能衰竭：肺是食管切除术后器官衰竭的起始部位。感染是发生呼吸衰竭最重要的危险因素。脓毒症患者出现糖耐量紊乱和蛋白质代谢异常，提示TPN在术后非常重要。4. 肝功能衰竭和MOF：术中肝脏缺血和术后严重感染导致的胆汁充血是肝功能衰竭的主要原因，提示肝脏能量代谢降低可能是MOF的危险因素。5. 梗阻性黄疸与MOF：梗阻性黄疸引起MOF的因素之一是内毒素引起的IgA分泌功能障碍导致免疫复合物增加。6. 胰腺炎和MOF：磷脂酶<A_2>引起的肾小管紊乱、肾小球和呼吸功能紊乱被确定为急性胰腺炎诱发MOF的原因。7. MOF和营养：在内毒素血症期间，葡萄糖代谢转变为高代谢状态，表明营养在MOF状态中的重要性。这些研究为系统研究MOF的发病机制铺平了道路，具有重要意义。进一步对各领域进行系统细致的研究，将为今后建立MOF的诊断标准提供有用的线索。少

Multiple organ failure (MOF) seen after operations is progressive and its prognosis is poor. This study was designed to clarify the mechanism of the development and pathophysiology of MOF and to seek for better treatment of MOF. As a result of a co-operative study from eight institutes, the following results were obtained. 1. DIC and MOF: DIC was one of the most important factors influencing MOF, often progressing in parallel with the degree of the pathological disturbances involving several organs. 2. Respiratory and circulatory failure and MOF: Thromboxane <A_2> was considered to be a mediator of respiratory and cardiac failure. The accumulation of neutrophils mediated by complement was one of the causes of respiratory failure. 3. MOF following esophagectomy: The lung is the initial site of organ failure following esophagectomy. Infection was the most important risk factor for the development of respiratory failure. In patients with sepsis, disturbances of glucose tolerance and abnor … More mal protein metabolism were also observed, suggesting that TPN is very important following operations. 4. Hepatic failure and MOF: Ischemia of the liver during operations and congestion of the bile due to severe postoperative infection were the major causes of hepatic failure, suggesting that lowered energy metabolism in the liver may be a risk factor for MOF. 5. Obstructive jaundice and MOF: One of the factors in obstructive jaundice induced MOF was the increase in immune complexes due to dysfunction of secretory IgA triggered by endotoxin. 6. Pancreatitis and MOF: Disturbances in the renal tubules caused by phospholipase <A_2> and the disturbance of the renal glomerulus and respiratory function were identified as a cause of acute pancreatitis inducing MOF. 7. MOF and nutrition: Glucose metabolism shifts to a hypermetabolic state during endotoxemia suggesting the importance of alimentation in MOF state. These studies are quite meaningful in that they have paved the way for a systemic study of the pathogenesis of MOF. Further systemic and detailed studies on each field will provide useful clue for future establishment of diagnostic criteria of MOF. Less