van Wessem K J P, Leenen L P H
Department of Trauma Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2014 Apr;40(2):127-34. doi: 10.1007/s00068-014-0392-9. Epub 2014 Mar 16.
Multiple organ dysfunction syndrome (MODS) is still a major threat to polytrauma patients, since sepsis-related organ failure is the most common cause of late mortality in these patients. In this article, the development of trauma surgery and evolution of trauma care from early total care to damage control surgery is discussed. Increasing knowledge of the pathophysiology of trauma has enabled us to identify the inflammatory response induced by trauma. By understanding the pathophysiology, we may be able to fully comprehend the origin of multiple organ dysfunction related sepsis. Further, it is important to appreciate the influence of surgery on the inflammatory response induced by trauma, and subsequently on the development of inflammatory complications. It is crucial to offer the polytrauma patient the appropriate type of surgery at the right time to prevent further deterioration.
MODS is still highly lethal, and once it has developed it is difficult to treat, so it is vital to be able to predict its occurrence. If we knew how to predict MODS, we might be able to develop strategies to prevent this syndrome.
多器官功能障碍综合征(MODS)仍然是多发伤患者面临的主要威胁,因为脓毒症相关器官衰竭是这些患者晚期死亡的最常见原因。本文讨论了创伤外科的发展以及创伤治疗从早期全面治疗到损伤控制手术的演变。对创伤病理生理学认识的不断增加使我们能够识别创伤诱导的炎症反应。通过了解病理生理学,我们或许能够充分理解与脓毒症相关的多器官功能障碍的起源。此外,认识手术对创伤诱导的炎症反应以及随后对炎症并发症发展的影响很重要。为多发伤患者在恰当时间提供合适类型的手术以防止病情进一步恶化至关重要。
MODS仍然具有很高的致死性,一旦发生就很难治疗,因此能够预测其发生至关重要。如果我们知道如何预测MODS,或许就能制定预防该综合征的策略。