Hirasawa H, Sugai T, Otake Y, Oda S, Shiga H
Department of Emergency and Critical Care Medicine, Chiba University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1989 Sep;90(9):1382-5.
Shock is defined as the summation of cellular dysfunction and resultant impairment of the function in various organs. The typical such condition can be observed in shock-induced multiple organ failure (MOF). Therefore, the most effective and fundamental management against shock should be the improvement of such cellular dysfunction. The present study was undertaken to investigate the cellular metabolic abnormalities and their treatment in shock-induced MOF patients. The severity of cellular damage was evaluated with cellular injury score (CIS), which can be calculated by scoring the values of osmolality gap, arterial ketone body ratio and blood lactate. The CIS correlated significantly with the outcome and the number of failing organs in the MOF patients. Since tissue hypoxia and humoral mediator have been considered to play a key role in the development of such cellular dysfunction, protease inhibitor was administered to such patients and oxygen metabolism was improved with catecholamine. The CIS improved among survived MOF patients following those treatments. These results suggest that the shock-induced MOF is the summation of the cellular dysfunction which can be assessed with the CIS, and that such cellular dysfunction could be improved through the therapeutic approach to the humoral mediators and/or tissue oxygen metabolism.
休克被定义为细胞功能障碍以及由此导致的各器官功能损害的总和。在休克诱发的多器官功能衰竭（MOF）中可以观察到典型的此类情况。因此，对抗休克最有效且根本的治疗方法应该是改善这种细胞功能障碍。本研究旨在调查休克诱发的MOF患者的细胞代谢异常及其治疗方法。细胞损伤程度通过细胞损伤评分（CIS）进行评估，该评分可通过对渗透压间隙、动脉酮体比值和血乳酸值进行评分来计算。CIS与MOF患者的预后及衰竭器官数量显著相关。由于组织缺氧和体液介质被认为在这种细胞功能障碍的发生中起关键作用，因此对这些患者给予蛋白酶抑制剂，并使用儿茶酚胺改善氧代谢。经过这些治疗后，存活的MOF患者的CIS有所改善。这些结果表明，休克诱发的MOF是可通过CIS评估的细胞功能障碍的总和，并且这种细胞功能障碍可通过针对体液介质和/或组织氧代谢的治疗方法得到改善。
