A STUDY ON THE TREATMENT FOR SEPTIC MULTIPLE ORGAN FAILURE THROUGH IMPROVEMENT OF TISSUE OXYGEN METABOLISM

本研究旨在探讨通过改善组织氧代谢来治疗脓毒症多器官衰竭（MOF）。首先，我们研究了临床适用的组织氧代谢评估方法。与氧输送和氧消耗同时测量的细胞损伤评分（CIS）是评估脓毒症 MOF 患者组织氧代谢紊乱的有用方法。眼压计测量胃粘膜内pH值（胃pHi）是新开发的用于监测内脏区域氧债的无创设备，也是临床上早期发现危重患者组织氧代谢紊乱的有用方法。根据这些结果，我们接下来研究了改善脓毒症 MOF 组织氧代谢的有效治疗方法。对严重脓毒症患者进行了血流动力学管理，通过积极的液体复苏和儿茶酚胺给药来实现超正常的氧输送值。这些治疗对早期脓毒症有效，可改善相对组织缺氧并预防器官功能障碍。然而，对于MOF极度发达的患者，这些治疗未能改善组织氧代谢，这可能主要是由于这些患者体内各种体液介质影响摄氧量减少所致。因此，虽然改善组织氧代谢的方法可能是脓毒症MOF的新治疗方法，但还应建立另一种方法来改善O_2提取以及血流动力学管理，以实现超正常的氧输送值。

This study was undertaken to investigate the treatment for septic multiple organ failure (MOF) through improvement of tissue oxygen metabolism. First, we investigated the clinically applicable methods for evaluation of tissue oxygen metabolism. Cellular injury score (CIS) measured simultaneously with oxygen delivery and oxygen consumption was a useful method to evaluate the disturbance of tissue oxygen metabolism in septic MOF patients. Gastric intramucosal pH (gastric pHi) measured by Tonometer, newly developed non-invasive device for monitoring of oxygen debt in visceral area, was also clinically useful method for early detection of the disturbance of tissue oxygen metabolism in critically ill patients. From these results, we next investigated the effective treatment for improvement of tissue oxygen metabolism in septic MOF.Hemodynamic management to achieve supranormal oxygen transport values with aggressive fluid resuscitation and catecholamine administration was carried out in patients with severe sepsis. These treatments were effective in early sepsis to improve relative tissue hypoxia and prevent organ dysfunction. However, in patients with extremely developed MOF,these treatments were failed to improve tissue oxygen metabolism, which supposed to be mainly due to decreased oxygen uptake affected by various humoral mediators in these patients. Thus, although approaches to improve tissue oxygen metabolism could be an new treatment for septic MOF,another approaches shoud be established to improve O_2 extraction as well as hemodynamic management to achieve supranormal oxygen transport values.