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

术后多器官功能衰竭（MOF）是一种进展性疾病，预后差。本研究旨在阐明多器官功能衰竭的发生、发展和病理生理机制，寻求更好的治疗方法。由于八个研究所的合作研究，取得了以下成果。1. DIC和MOF：DIC是影响多器官功能衰竭的重要因素之一，常与多个器官的病理损害程度平行发展。2.呼吸和循环衰竭以及多器官功能衰竭：血栓烷<A_2>被认为是呼吸和心力衰竭的介质。补体介导的中性粒细胞聚集是呼吸衰竭的原因之一。3.食管切除术后多器官衰竭：肺是食管切除术后器官衰竭的初始部位。感染是发生呼吸衰竭的最重要危险因素。在脓毒症患者中，葡萄糖耐量和糖耐量异常 ...更多信息 术后蛋白质代谢异常，提示术后TPN是非常重要的。4.肝衰竭和MOF：术中肝脏缺血和术后严重感染引起的胆汁淤积是导致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.梗阻性黄疸和MOF：内毒素引起IgA分泌伊加障碍，导致免疫复合物增多，是梗阻性黄疸致MOF的重要因素之一。6.胰腺炎和MOF：磷脂酶引起的肾小管紊乱<A_2>以及肾小球和呼吸功能紊乱被确定为急性胰腺炎诱导MOF的原因。7.多器官功能衰竭与营养：内毒素血症时葡萄糖代谢转为高代谢状态，提示营养在多器官功能衰竭状态中的重要性。这些研究为系统研究多器官功能衰竭的发病机制奠定了基础，具有重要意义。对各个领域的深入系统研究将为今后多器官功能衰竭诊断标准的建立提供有益的线索。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