Steinberg Steven M
Ohio State University College of Medicine, 410 W. 10th Ave., Doan Hall N-717, Columbus, OH 43210, USA.
Am J Surg. 2003 Sep;186(3):301-5. doi: 10.1016/s0002-9610(03)00220-4.
The reasons our critically ill patients die have been a matter of great interest for many decades, with the hope that if we can identify the mechanisms responsible for death, we might be able to intervene and improve outcome. Over the last 1 to 2 decades, the concept of bacterial translocation-the movement of gut origin microbes across the intact gastrointestinal tract into normally sterile tissues where the organisms may then directly cause infection or incite an inflammatory response that causes tissue injury, organ failure, and death-has grown to the point where it is virtually impossible to make rounds in any intensive care setting without a resident or student blaming some complication or another on bacterial translocation. We will attempt to review the clinically relevant information that supports and refutes the concept of bacterial translocation as a cause of our critically ill patients to exhibit the symptoms and signs of sepsis, develop organ failure, and ultimately die.
几十年来,我们重症患者死亡的原因一直备受关注,人们希望如果能够确定导致死亡的机制,或许就能进行干预并改善预后。在过去的10到20年里,细菌移位的概念——即源自肠道的微生物穿过完整的胃肠道进入通常无菌的组织,在那里这些微生物可能直接引起感染或引发炎症反应,进而导致组织损伤、器官衰竭和死亡——已经发展到在任何重症监护环境中查房时,几乎都会有住院医生或学生将某种并发症归咎于细菌移位的程度。我们将试图回顾支持和反驳细菌移位这一概念的临床相关信息,细菌移位被认为是导致我们的重症患者出现脓毒症症状和体征、发生器官衰竭并最终死亡的原因。