Jensen T H, Heslet L, Fomsgaard A
Rigshospitalet, anaestesi- og intensiv afdeling, København.
Ugeskr Laeger. 1993 Sep 13;155(37):2861-6.
A review of bacterial translocation and multiple organ failure (MOF) is presented. Splanchnic ischaemia plays a central role in the development of MOF, but the exact mechanism of translocation is unclear. The concentration of endotoxins and bacteria in the gut is high. The critically ill patient is often treated with antibiotics with a broad antibacterial spectrum and overgrowth of Gram negative bacteria will take place in the gut favouring the translocation phenomenon. The regime of selective gut decontamination is discussed. Regional and systemic oxygen kinetics together with metabolic markers are important in detecting splanchnic ischaemia. Hepatic vein catheterisation and gastric mucosa pHi are discussed. The regional inflammation in the gut is often initiated by endotoxins, which stimulate the cytokines IL-1, IL-6 and TNF. Another important factor that can accentuate inflammation of the gut is reperfusion injury. A proposal for treatment of splanchnic ischaemia and translocation is discussed i.e.: optimizing central haemodynamic parameters, optimizing the regional microcirculation, treatment with antibodies to endotoxins, gut decontamination and early enteral nutrition. When splanchnic hypoperfusion is detected it cannot be ignored. It may be possible to correct the hypoperfusion with early gastrointestinal resuscitation and to thereby reduce the duration and mortality of MOF. The above mentioned suggestions are all very demanding of resources, but have to be considered in gut directed therapy.
本文对细菌移位和多器官功能衰竭（MOF）进行了综述。内脏缺血在MOF的发生发展中起核心作用，但移位的确切机制尚不清楚。肠道内毒素和细菌浓度很高。危重病患者常接受广谱抗生素治疗，肠道内革兰阴性菌会过度生长，从而促进移位现象。文中讨论了选择性肠道去污方案。区域和全身氧动力学以及代谢标志物在检测内脏缺血方面很重要。文中还讨论了肝静脉插管和胃黏膜pHi。肠道局部炎症通常由内毒素引发，内毒素会刺激细胞因子IL-1、IL-6和TNF。另一个可加重肠道炎症的重要因素是再灌注损伤。文中讨论了治疗内脏缺血和移位的建议，即：优化中心血流动力学参数、优化局部微循环、使用抗内毒素抗体治疗、肠道去污和早期肠内营养。当检测到内脏灌注不足时，不能忽视。早期胃肠道复苏可能纠正灌注不足，从而缩短MOF的持续时间并降低其死亡率。上述建议都对资源要求很高，但在肠道定向治疗中必须予以考虑。
