Waydhas C, Nast-Kolb D, Jochum M, Trupka A, Lenk S, Fritz H, Duswald K H, Schweiberer L
Department of Surgery, Ludwig Maximilians-University, Munich, Germany.
Arch Surg. 1992 Apr;127(4):460-7. doi: 10.1001/archsurg.1992.01420040106019.
The relation of (multiple) organ failure (OF) to the release of inflammatory mediators and the incidence of infection and sepsis was studied prospectively in 100 patients with multiple trauma (injury severity score = 37). Sixteen patients died of OF, 47 patients survived OF, and 37 patients had no OF. Fifteen (24%) of the patients with OF showed no signs of infection. In patients with early onset of OF (n=45), infection followed with a lag of 2 or more days. In 16 (44%) of these patients, infection led to a deterioration in organ function. With late onset of OF (n=18), infection preceded OF in nine patients. Polymorphonuclear leukocyte-elastase, neopterin, C-reactive protein, lactate, antithrombin III, and phospholipase A discriminated significantly among the three outcome groups. Of all factors, only polymorphonuclear leukocyte-elastase showed a difference between patients with and without infection or sepsis, respectively. These data indicate that infection might not play a crucial role in the pathogenesis of posttraumatic OF in a substantial portion of patients with trauma. Early OF, especially, seems to be mainly influenced by the direct sequelae of tissue damage and shock (eg, the release of inflammatory mediators). Since infection and sepsis did not lead to an augmented release of mediators in patients with trauma, the role of both entities remains unclear.
对100例多发伤患者（损伤严重度评分=37）进行前瞻性研究，探讨（多）器官功能衰竭（OF）与炎症介质释放、感染及脓毒症发生率之间的关系。16例患者死于OF，47例患者OF存活，37例患者未发生OF。15例（24%）发生OF的患者无感染迹象。在OF早期发生的患者（n=45）中，感染在2天或更长时间后出现。其中16例（44%）患者，感染导致器官功能恶化。在OF晚期发生的患者（n=18）中，9例患者感染先于OF出现。多形核白细胞弹性蛋白酶、新蝶呤、C反应蛋白、乳酸、抗凝血酶III和磷脂酶A在三个结局组之间有显著差异。在所有因素中，只有多形核白细胞弹性蛋白酶在有或无感染或脓毒症的患者之间分别显示出差异。这些数据表明，在相当一部分创伤患者中，感染可能在创伤后OF的发病机制中不起关键作用。特别是早期OF，似乎主要受组织损伤和休克的直接后遗症（如炎症介质的释放）影响。由于感染和脓毒症在创伤患者中并未导致介质释放增加，两者的作用仍不明确。
