Pape H C, Remmers D, Kleemann W, Goris J A, Regel G, Tscherne H
Department of Trauma Surgery, Hannover Medical School, Germany.
Shock. 1994 Sep;2(3):228-34. doi: 10.1097/00024382-199409000-00012.
In a retrospective analysis, clinical data and histological specimens were obtained from patients (n = 59) who died of severe injury. Three groups with comparable injury severity were differentiated according to the time of death. In group A (death, within 24 h) (n = 15) despite multiple injuries, patients almost always died from brain injury. Pulmonary failure was the leading cause of death in group B (death, days 2-7) (n = 16). The majority of group C patients (death, > 7 days) (n = 28) died of multiple organ failure. Organ weights at autopsy were all pathologically high but did not show an association with the amount of intravenous volume infused during intensive care. Organ histology revealed signs of interstitial edema and infiltration of polymorphonuclear leukocytes in group B patients especially in the lung, and in all groups to a lower degree in liver and kidney. The distribution of interstitial edema and cell necrosis appeared to be organ-specific. Our data confirm the presence of a generalized inflammatory reaction in patients with severe trauma. The pattern of organ failure, in addition to known pathogenetic changes (mediators, endotoxemia, etc.), appears to be influenced by organ structure and perfusion.
在一项回顾性分析中，从死于重伤的患者（n = 59）处获取了临床数据和组织学标本。根据死亡时间将损伤严重程度相当的患者分为三组。A组（死亡时间在24小时内）（n = 15）的患者尽管多处受伤，但几乎总是死于脑损伤。B组（死亡时间在第2至7天）（n = 16）中，肺衰竭是主要死因。C组大多数患者（死亡时间超过7天）（n = 28）死于多器官衰竭。尸检时的器官重量均在病理上偏高，但与重症监护期间输入的静脉液体量无关。器官组织学检查显示，B组患者尤其是肺部出现间质水肿和多形核白细胞浸润的迹象，所有组的肝脏和肾脏也有程度较低的上述情况。间质水肿和细胞坏死的分布似乎具有器官特异性。我们的数据证实了严重创伤患者存在全身性炎症反应。除了已知的发病机制变化（介质、内毒素血症等）外，器官衰竭的模式似乎还受器官结构和灌注的影响。
