Baue A E
Shock. 1994 Dec;2(6):385-97. doi: 10.1097/00024382-199412000-00001.
Multiple organ failure, multiple organ dysfunction syndrome, and the systemic inflammatory response syndrome are problems of medical progress and intensive care units (ICUs) and require prevention of organ failure through excellent patient care. New concepts in prevention include: 1) the need to improve microcirculatory blood flow (Mbf) early after injury or illness, 2) stopping or controlling injury or infection by early definitive operation when necessary, 3) a zero defect operation is necessary, 4) necrotic tissue and an overwhelming inflammatory burden are problems and should be lessened when possible, 5) adequate resuscitation to improve Do2, Vo2, and organ blood flow is necessary, 6) supporting metabolism and the GI tract may decrease complications of injury and sepsis, 7) support of host defense and/or immunomodulation to decrease the incidence of sepsis, and 8) treating the patient and the illness or injury, not just the mediators. Experimental evidence in animals and human volunteers for concepts, mechanisms, and treatment of injury or illness can be substantial and persuasive, but it may be difficult to demonstrate efficacy in sick patients. Clinical situations are variable and complex. It is difficult to dissect out, identify, and control or block a single factor or mediator. All biologic processes require a level of activity that can be hazardous in excess but dangerous if decreased or eliminated. Stimulation of our natural defense or control mechanisms of inflammation, replacement of lost or decreased factors, and better understanding of the interrelationships and mechanisms of inflammation will contribute to therapy. Whether blockade of mediators or treatment of the manifestations of diseases or injuries will have substantial impact remains to be learned. A single magic bullet for complex and diverse illnesses is not likely to appear or to be successful. In this review it was not possible to describe many of the observations and recommendations in this immense and complex field. I apologize to those whose work I have inadvertently not included.
多器官功能衰竭、多器官功能障碍综合征和全身炎症反应综合征是医学进步和重症监护病房（ICU）面临的问题，需要通过优质的患者护理来预防器官功能衰竭。预防的新概念包括：1）在受伤或患病后早期改善微循环血流量（Mbf）的必要性；2）必要时通过早期确定性手术停止或控制损伤或感染；3）必须进行零缺陷手术；4）坏死组织和过度的炎症负荷是问题所在，应尽可能减轻；5）进行充分的复苏以改善氧输送（Do2）、氧消耗（Vo2）和器官血流量是必要的；6）支持代谢和胃肠道可能会减少损伤和脓毒症的并发症；7）支持宿主防御和/或免疫调节以降低脓毒症的发生率；8）治疗患者以及疾病或损伤，而不仅仅是介质。关于损伤或疾病的概念、机制和治疗，动物和人类志愿者的实验证据可能丰富且有说服力，但在患病患者中证明其疗效可能很困难。临床情况多变且复杂。很难分离、识别和控制或阻断单一因素或介质。所有生物过程都需要一定水平的活性，活性过高可能有害，但如果降低或消除则可能危险。刺激我们天然的防御或炎症控制机制、补充缺失或减少的因素以及更好地理解炎症的相互关系和机制将有助于治疗。介质阻断或疾病或损伤表现的治疗是否会产生重大影响仍有待了解。不太可能出现或成功找到针对复杂多样疾病的单一神奇疗法。在这篇综述中，不可能描述这个庞大而复杂领域中的许多观察结果和建议。对于那些我无意中未纳入其工作的人，我深表歉意。
