老年多器官衰患者外周血白细胞糖皮质激素受体改变及其意义

应用放射配体结合法检测老年多器官衰竭（ＭＯＦＥ）患者外周血单个核白细胞（ＭＮＬ）糖皮质激素受体（ＧＲ）的结合量，并与成年人多器官衰竭（ＭＯＦ）和单一器官衰竭进行比较。结果显示ＭＯＦＥ患者ＭＮＬ的ＧＲ结合量明显降低，而血浆皮质醇（Ｆ）则升高。单一器官衰竭时，ＭＮＬ的ＧＲ结合容量也下降，但幅度较ＭＯＦＥ时小。实验结果提示，ＧＲ的改变参与ＭＯＦ的病理生理过程，检测ＧＲ可作为判断ＭＯＦ严重程度的指标和监测     

多器官障碍综合征(MODS)和全身炎症反应综合征(SIRS)

近年来，不少学者认为，应该用多器官障碍综合征（MODS）代替以往所称的多器官功能衰竭（MOF）。对于MODS的发病机制虽然尚未完全阐明，但是目前认为它与全身炎症反应综合征（SIRS）的关系十分密切。下面将围绕MODS和SIRS的某些进展作一简单介绍。1、MOF与MODS70年代Tilney在一组胸主动脉瘤破裂的病人大手术后发现，患者在本后恢复过程中陆续发生多个器官系统功能衰竭，当时称其为相继发生的系统功能衰竭（sequentialsystemfallure）。80年代Dr．Baue较全面地观察分析了外科手术后病人发生的器官功能衰竭，因而明确提出了多器…     

实验性多器官衰竭时肝线粒体氧化还原电位及血浆氨基酸含量的变化

本文利用低血流灌注引起大鼠多器官衰竭(MOF)模型,结合重要器官病理变化,对MOF发生、发展过程的肝线粒体氧化还原电位及血浆氨基酸谱变化进行了观察。     

中晚期肝癌并发多器官功能衰竭的观察与护理

目的探讨中晚期肝癌患者并发多器官功能衰竭(MOF)时,做好基础护理,以提高护理质量.方法总结中晚期肝癌并发MOF病人的特点.结果患者出现MOF最常见的诱发因素是感染.首发和多发衰竭器官是肝功能衰竭及肝性脑病,同时出现2个或3个器官衰竭较多见,故病情复杂而危重,处理不当病死率较高.结论避免其诱发因素,及早发现MOF,加强护理并积极治疗是延长病人生命,减轻病人痛苦,提高生活质量的关键.     

中晚期肝癌并发多器官功能衰竭的观察与护理

目的　探讨中晚期肝癌患者并发多器官功能衰竭 (MOF)时 ,做好基础护理 ,以提高护理质量 .方法　总结中晚期肝癌并发MOF病人的特点 .结果　患者出现MOF最常见的诱发因素是感染 .首发和多发衰竭器官是肝功能衰竭及肝性脑病 ,同时出现 2个或 3个器官衰竭较多见 ,故病情复杂而危重 ,处理不当病死率较高 .结论避免其诱发因素 ,及早发现MOF ,加强护理并积极治疗是延长病人生命 ,减轻病人痛苦 ,提高生活质量的关键 .     

多器官衰竭综合征小鼠模型的炎性细胞因子变化

MoniqueJetalCritCareMed．-1996；24（7）．-1096～1120多器官衰竭综合征（MOF）是急救科和外科死亡的主要原因，而巨噬细胞M的持续活化和全身性炎性细胞因子增加在MOF的发生机理中起重要作用。用小鼠模型研究了MOF时血清中细胞因子和M产生细胞因子能力的变化。以1mg／g体重的剂量腹腔注射酵母多糖，诱导C57BC／C雄鼠产生类似人MOF的症状。观察12天中的①小鼠的一般状况；②血清中IL－la，IL－18，TNG－a和IL－6，TNF－a的生物学活性；腹腔＊O及其在体外＊％（IO吵m！）刺激后产生细胞因子的能力等变化。酵母多糖诱导的小…     

老年人急性脑血管病并发多器官功能衰竭的护理体会

当老年人发生重症脑出血或脑梗死时,全身多个器官可同时或序贯出现功能障碍或衰竭,其死亡率极高.因此,做好多器官损伤的护理,防止MOFE的发生,是急性脑血管意外护理工作中很重要的环节,本文分析了98例急性脑血管病并发MOFE的观察护理特点,加强器官的护理,认真做好基础护理和心理护理, 收到了较好的护理效果.     

老年人急性脑血管病并发多器官功能衰竭的护理体会

当老年人发生重症脑出血或脑梗死时 ,全身多个器官可同时或序贯出现功能障碍或衰竭 ,其死亡率极高 .因此 ,做好多器官损伤的护理 ,防止MOFE的发生 ,是急性脑血管意外护理工作中很重要的环节 ,本文分析了 98例急性脑血管病并发MOFE的观察护理特点 ,加强器官的护理 ,认真做好基础护理和心理护理 ,收到了较好的护理效果 .     

重型病毒性肝炎与多系统器官功能衰竭——附9例临床分析

对９６例重型病毒性肝炎并发多系统器官功能衰竭（ＭＳＯＦ）的患者进行了分析慢性重型病毒性肝炎多系统器官功能衰竭的发生率为６７．７％（６５／９６），亚急性重型肝炎为２８．１３％（２７／９６），急性重型肝炎为４．１７％（４／９６）。慢性重型肝炎发生衰竭的系统器官数目最多（平均３．２８个），急性重型肝炎最少（平均２．５个）。衰竭系统器官越多，病死率越高，衰竭系统器官为１个的病死率是７．６９，≥４个的病死率     

乌司他丁对严重烧伤后脏器的保护作用

随着烧伤休克复苏和创面修复技术提高以及临床监测技术和生命支持手段（抗生素、营养支持疗法和ICU）的发展，严重患者的救治率有所提高，但仍有许多患者最终因并发烧伤后多器官功能障碍（multiple organ dysfunction syndrome，MODS）甚至发展为多器官功能衰竭（muhiple orsan failure，MOF）而死亡。MODS病死率仍徘徊在50％-80％之间，这种状况在世界范围内没有改变，成为影响危重患者的主要死亡原因。MODS的发生和发展，     

Changes in lymphocyte subsets, neutrophil function and complement levels in patients with complications following open heart surgery

In order to evaluate the immune response during and after open heart surgery, we have studied 34 patients who received open heart surgery under extracorporeal circulation. Age range of these patients were from 41 to 76 years. These patients were divided into three groups, depending upon existence of multiple organ failure (MOF), low output syndrome (LOS) and non-LOS and non-MOF diagnosed from our criteria. The following cytological and immunological study has been performed pre-operatively, immediately after and on 1, 2, 7 and 14th postoperative day; 1) the leukocyte differential cell count, 2) function test of neutrophils, 3) lymphocyte subpopulation and subsets, 4) serum level of complement fractions (C3, C4) and CH 50. By lymphocytes analysis, postoperative early reduction of OKT 3 (CD 3) and OKT 4 (CD 4) was observed in patients with poor prognosis. Patients with the postoperative high activity of NBT reduction test was developed into MOF. Complement activity (C3, C4, CH50) decreased during surgery and recovered to preoperative level in patients without LOS and MOF. However in MOF patients, these values showed lower level than that of patients without LOS and MOF. Our data suggested that lymphocytes and leukocytes tests were useful to evaluate the prognosis in open heart surgery.     

脑出血患者外周血白细胞糖皮质激素受体及其效应指标的改变及意义

应用放射配体结合法，测定了56例脑出血患者外周血白细胞糖皮质激素受体（GR）的改变。结果发现脑出血组血浆皮质醇均明显升高，但白细胞GR随出血量的增多而降低越明显，并同时伴有氢化可的松（F）对中性多形核白细胞（PMN）趋化移动（ChtM）抑制率（FI）的降低。故测定GR有助于对病情及预后的判断。     

APACHE Ⅱ与APACHE Ⅲ在内科重症监护病房中的应用

应用Knaus等提出的急性生理学与慢性健康评价(APACHE)Ⅱ、Ⅲ预测评分系统,观察了内科重症监护病房中呼吸衰竭和急性心肌梗塞的64例患者,并与衰竭脏器的个数及脏器衰竭的严重程度计分作对照,发现APACHEⅡ、APACHEⅢ预测系统评分与患者的预后有明显的相关性:分值越高,病情越重,预后越差,死亡率越高。APACHE预测评分系统与患者预后判断的相关性和准确性,均优于脏器衰竭及其严重程度的计分方法。     

Role of phospholipase A in multiorgan failure with special reference to ARDS and acute renal failure (ARF)

Summary In 150 patients admitted to an ICU phospholipase A serum activity was measured daily. The correlation between the increase of phospholipase A serum activity and the severity of adult respiratory distress syndrome (ARDS) and the incidence of acute renal failure (ARF), two important target systems in multiple organ failure (MOF) syndrome was studied as well as the efficacy of a treatment with phospholipase A inhibitors (methylprednisolone and dexamethasone). The results of this study show that there exists a statistically significant correlation between the increase of phospholipase A activity and the incidence of multiple organ failure. Inhibitory treatment ameliorates the organ function for a short time without any change of long-term outcome. The results could not clarify whether the rise of the mother enzyme of the arachidonic acid metabolism is only an epiphenomenon of multiple organ failure or the causative agent itself.     

在多器官功能衰竭中氧自由基与细菌感染的关系的实验研究

本文用家兔实验性MSOF的摸型,观察血浆、组织丙二醛含量改变,细菌感染的变化规律与各脏器功能损害的关系。结果提示:创伤后氧山由基损害与感染关系十分密切,二者相互作用共同参与了MSOF发生的病理过程。     

Intestinal permeability and cytokine inflammatory response in multiply injured patients.

In experimental settings, the increased intestinal permeability (IP) following severe trauma is associated with increased serum concentrations of cytokines. Multiply injured patients are susceptible to the development of multiple organ failure (MOF). The aim of this study was to determine if altered IP after trauma was associated with upregulation of cytokines and if cytokines and IP influenced the development of MOF. In 30 multiply injured patients, IP was measured on days 2 and 4 after injury using the lactulose-mannitol (L-M) test, and the levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and IL-8 were determined simultaneously. The L-M ratio increased significantly from 0.049 (0.017-0.133) on day 2 to 0.150 (0.059-0.339) on day 4 (p < 0.02) On day 4, a significant correlation was also found between the L-M ratio and IL-6 (r = 0.43, p < 0.03). The IL-6 level on days 2 and 4 was significantly (p < 0.01 and p < 0.03, respectively) higher in MOF patients than in those without MOF, as was the TNF-alpha level on day 4 significantly higher (p < 0.04) in MOF patients. IP increases following multiple trauma, and on day 4 it correlates with the IL-6 level. However, in patients who develop MOF only cytokines are invariably increased, with IL-6 alone being significantly increased on both measurements in these patients.     

应用内皮细胞平铺技术观察多器官衰竭内皮细胞的形态

应用内皮细胞平铺技术观察家兔多器官衰竭血管内皮细胞的形态变化。结果，平铺切片显示多器官衰竭时内皮细胞受到明显损伤，表现为明显的变性、坏死和脱落。证实内皮细胞损伤在多器官衰竭发病过程中是一个重要因素     

环孢霉素A对人单个核白细胞糖皮质激素受体和雌激素受体的影响及意义

用放射配体结合分析，体外实验观察了环孢霉素Ａ（ＣｓＡ）、环磷酰胺（ＣＴＸ）及甲基强的松龙对人单个核白细胞（ＭＮＬ）的糖皮质激素受体（ＧＲ）和雌激素受体（ＥＲ）结合容量的影响，以阐明ＣｓＡ免疫抑制作用的机制，并为联合用药提供理论依据。当ＣｓＡ浓度为１００ｎｇ／ｍｌ时，ＧＲ和ＥＲ的结合容量无改变；５００和１０００ｎｇ／ｍｌ时，ＧＲ结合容量升高３０％左右，ＥＲ的降低３０％左右；２０００和１００００ｎｇ／ｍｌ时，ＧＲ和ＥＲ结合容量均降低５０％左右。ＣＴＸ和甲强龙均使ＧＲ和ＥＲ结合容量降低。当ＣｓＡ与ＣＴＸ和甲强龙合用时，可以逆转ＣＴＸ和甲强龙对ＧＲ的抑制作用，故可充分发挥免疫抑制作用。     

Neutrophil hypochlorous acid production is impaired in multiple organ failure patients with candidaemia; reversal with antifungal agents

OBJECTIVE AND DESIGN: Neutrophil-derived hypochlorous acid (PMN-HOCL) is a potent bactericidal and fungicidal agent. Neutrophils from patients with multiple organ failure (MOF) have an altered ability to inhibit Candida albicans. Conversely antifungal agents are effective in decreasing mortality in MOF patients with fungaemia. We determined the effect on the rate of production of PMN-HOCL in a series of MOF patients with C. albicans fungaemia when antifungal agents are administered. SUBJECTS AND METHODS: Eleven patients with MOF were recruited. Four patients had culture-positive C. albicans fungaemia (group 1) and 7 patients with MOF but without C. albicans fungaemia acted as controls (group 2). HOCL assays were performed on peripheral blood PMN obtained from group 1 and group 2 patients. RESULTS: The maximum PMN-HOCL production rate for group 1 increased from 0.24 nmol/million PMN/min to 0.8 nmol/million PMN/min after treatment with antifungal agents (p < 0.01) (Mann-Whitney U test) whereas the PMN-HOCL kinetic (rate) curves for group 1 post-treatment and for group 2 were similar (student's-t-test). CONCLUSIONS: These findings suggest that antifungal treatment improve PMN-HOCL production in MOF patients with C. albicans fungaemia and may improve the effectiveness in eradicating the organism.     

血液净化治疗多器官衰竭

广泛性失去控制的炎症细胞活化和炎症介质释放在多器官衰竭的发病过程中起重要作用。近年来 ,由于监护病房的建立和诊断治疗水平的不断提高 ,使死亡率有所下降 ,但仍不理想。衰竭器官大于 3个以上者 ,几乎 10 0 %死亡。作为一种人工支持疗法 ,血液净化早已为人们熟知。最近 ,越来越多的学者将其用于多器官衰竭的治疗 ,藉以清除循环中过多的炎症介质 ,减轻或预防组织器官的病理损害。本文介绍了目前常用于治疗多器官衰竭的血液净化方法。