Bone R C, Balk R, Slotman G, Maunder R, Silverman H, Hyers T M, Kerstein M D
Rush-Presbyterian-St. Luke's Medical Center, Chicago 60612.
Chest. 1992 Feb;101(2):320-6. doi: 10.1378/chest.101.2.320.
To determine the epidemiology of multiple organ failure (MOF) in patients with the adult respiratory distress syndrome.
We followed up 50 patients with serial determinations of respiratory and nonrespiratory organ function for seven days after diagnosis.
Data were stratified between patients who died and those who survived (defined as hospital discharge).
Values that did not differ at any time between the two groups of patients included oxygen availability, oxygen consumption, oxygen extraction, PaCO2, respiratory rate, heart rate, systolic blood pressure, cardiac output, stroke index, systemic vascular resistance, and temperature. Patients who died had greater defects in oxygenation (from day 1 through day 7). They also exhibited decreased arterial oxygen content (from day 1 to day 4), decreased mixed venous oxygen content (day 1), increased peak inspiratory pressure (present on day 2, persisted to day 5, reappeared on day 7), decreased diastolic blood pressure (seen on days 1 through 3, reappeared on day 7), and increased mean pulmonary artery pressure (seen on days 2 and 3). Nonsurvivors also exhibited greater degrees of thrombocytopenia (from day 1 to day 4). Decreases in pH (seen on day 1, reappeared from days 4 to 7), abnormalities in liver function (seen only on day 1), and increases in serum creatinine levels (appeared on day 7) were also observed.
Multiorgan dysfunction (MOD) was frequently observed in both groups of patients. Alterations in organ function and the pattern of abnormalities were often subtle and would not be characterized as significant organ dysfunction by most available organ scoring systems. Adult respiratory distress syndrome is a manifestation of systemic disease produced by widespread increases in endothelial permeability; lung dysfunction dominates the early clinical course. When respiratory function is supported, it becomes evident that alterations occur in other organs. Multiorgan failure is really a misnomer; the term emphasizes end-stage changes. Multiorgan dysfunction is common and often resolves without progressing to MOF. Alternatively, MOD can progress to MOF.
确定成人呼吸窘迫综合征患者多器官功能衰竭（MOF）的流行病学情况。
我们对50例患者进行了随访，在诊断后连续7天测定其呼吸和非呼吸器官功能。
数据按死亡患者和存活患者（定义为出院）进行分层。
两组患者在任何时间均无差异的数值包括氧供、氧耗、氧摄取、动脉血二氧化碳分压、呼吸频率、心率、收缩压、心输出量、每搏指数、全身血管阻力和体温。死亡患者的氧合功能障碍更严重（从第1天至第7天）。他们还表现出动脉血氧含量降低（从第1天至第4天）、混合静脉血氧含量降低（第1天）、吸气峰压升高（出现在第2天，持续至第5天，第7天再次出现）、舒张压降低（在第1天至第3天出现，第7天再次出现）以及平均肺动脉压升高（在第2天和第3天出现）。未存活者还表现出更严重的血小板减少（从第1天至第4天）。还观察到pH值降低（在第1天出现，从第4天至第7天再次出现）、肝功能异常（仅在第1天出现）以及血清肌酐水平升高（出现在第7天）。
两组患者均经常观察到多器官功能障碍（MOD）。器官功能改变和异常模式往往很细微，大多数现有的器官评分系统不会将其特征化为严重器官功能障碍。成人呼吸窘迫综合征是内皮通透性广泛增加所导致的全身性疾病的一种表现；肺功能障碍在早期临床过程中占主导地位。当呼吸功能得到支持时，其他器官出现改变就变得明显。多器官功能衰竭实际上是一个不恰当的名称；该术语强调终末期变化。多器官功能障碍很常见，且通常在不进展为MOF的情况下得到缓解。或者，MOD可进展为MOF。
