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败血症多器官功能衰竭(MOF)。首先，我们研究了临床上可用于评估组织氧代谢的方法。细胞损伤评分(CIS)与氧输送和氧耗量同步测定是评估感染性MOF患者组织氧代谢紊乱的有效方法。应用新近研制的无创内脏氧债监测装置--胃黏膜内pH(胃液pH值)测定，也是早期发现危重病人组织氧代谢紊乱的有效方法。根据这些结果，我们接下来探讨了改善脓毒症MOF组织氧代谢的有效治疗方法。对严重脓毒症患者进行血流动力学管理，通过积极的液体复苏和儿茶酚胺的应用，实现超常的氧转运。这些治疗对早期脓毒症有效，可改善相对组织缺氧和预防器官功能障碍。然而，在极度发达的MOF患者中，这些治疗未能改善组织的氧代谢，这可能主要是由于这些患者受到各种体液介质影响而导致的氧摄取减少所致。因此，虽然改善组织氧代谢的方法可能是感染性MOF的一种新的治疗方法，但应该建立另一种方法来改善氧摄取和血流动力学管理，以达到超常的氧转运价值。

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.