Konno H, Koyano K, Matin A F, Aoki K, Nakamura S, Baba S, Sakaguchi S
Second Department of Surgery, Hamamatsu University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1992 Aug;93(8):779-83.
The clinical features of 22 postoperative multiple organ failure (MOF) patients, comprised of 8 with arterial disease (A-MOF) and 14 with gastrointestinal cancer (G-MOF), were investigated. Differences in the operative time, blood loss, and mortality were not significant. The initial organ impaired was the lungs in 78.6% of G-MOF patients and the heart or kidneys in all A-MOF patients. Infection developed in over 80% of both groups. In many A-MOF patients, the pneumonia or septicemia developed secondary to organ failure, while intraabdominal infection triggered respiratory failure in many G-MOF patients. Our organisms in infected specimens and their antibiotic sensitivities was valuable for the early administration of effective antibiotics. Upper gastrointestinal tract bleeding was important in the prognosis of both groups and occurred more frequently in A-MOF than in G-MOF patients. Consumption coagulopathy in A-MOF patients and DIC induced by infection in G-MOF patients mainly caused such bleeding. Preoperative administration of heparin was effective in improving coagulopathy. Furthermore, measurement of intramural pH with tonometer in the stomach and gastric irrigation with oxygenated perfluorochemicals were effective in the prediction and prevention of gastrointestinal bleeding.
对22例术后多器官功能衰竭（MOF）患者的临床特征进行了调查，其中8例患有动脉疾病（A-MOF），14例患有胃肠道癌（G-MOF）。手术时间、失血量和死亡率方面的差异不显著。在G-MOF患者中，78.6%的患者最初受损的器官是肺，而在所有A-MOF患者中最初受损的器官是心脏或肾脏。两组中超过80%的患者发生了感染。在许多A-MOF患者中，肺炎或败血症继发于器官功能衰竭，而在许多G-MOF患者中，腹腔内感染引发了呼吸衰竭。感染标本中的微生物及其抗生素敏感性对于早期使用有效抗生素很有价值。上消化道出血对两组患者的预后都很重要，且在A-MOF患者中比在G-MOF患者中更频繁发生。A-MOF患者的消耗性凝血病和G-MOF患者感染引起的弥散性血管内凝血（DIC）是此类出血的主要原因。术前给予肝素对改善凝血病有效。此外，用眼压计测量胃壁内pH值以及用含氧全氟化合物进行胃灌洗对胃肠道出血的预测和预防有效。
