Rensing H, Bauer M
Klinik für Anaesthesiologie und Intensivmedizin, Universität des Saarlandes, Kirrberger Strasse, Gebäude 57, 66421 Homburg/Saar.
Anaesthesist. 2001 Nov;50(11):819-41. doi: 10.1007/s001010100217.
Multiple organ failure (MOV) still represents the leading medical and economical problem in the care of the critically ill surgical patient. Although the incidence of MOF has tended to decrease over the last several years reflecting improved surgical and supportive therapy in the ICU, prognosis still remains serious when MOF develops. MOF seems to reflect a dysregulation of host-defence systems, such as innate immune, coagulation and complement systems, which are likely to reflect a more general dysregulation of cellular and subcellular functions, such as signal transduction and stress gene expression. Besides complexity and redundancy of the mediator systems involved, their beneficial local reparative as opposed to detrimental systemic effects may have contributed to the disappointing results of anti-mediator strategies in the treatment of MOF and sepsis. Although treatment of the underlying disease remains the cornerstone of the care of the critically ill patient to prevent MOF, recent results indicating a decreased mortality in severely septic patients receiving activated protein C as a supportive treatment suggest that modulation of the mediator cascades of sepsis and MOF remains a generally promising therapeutic strategy.
多器官功能衰竭（MOF）仍是重症外科患者治疗中主要的医学和经济问题。尽管在过去几年中，由于重症监护病房（ICU）手术和支持治疗的改善，MOF的发病率呈下降趋势，但MOF一旦发生，预后仍然严重。MOF似乎反映了宿主防御系统的失调，如天然免疫、凝血和补体系统，这可能反映了细胞和亚细胞功能的更普遍失调，如信号转导和应激基因表达。除了所涉及的介质系统的复杂性和冗余性外，它们有益的局部修复作用与有害的全身作用可能导致了抗介质策略在治疗MOF和脓毒症方面令人失望的结果。虽然治疗基础疾病仍然是预防MOF的重症患者护理的基石，但最近的结果表明，接受活化蛋白C作为支持治疗的严重脓毒症患者死亡率降低，这表明调节脓毒症和MOF的介质级联反应仍然是一种普遍有前景的治疗策略。
