Kirkpatrick C J, Bittinger F, Klein C L, Hauptmann S, Klosterhalfen B
Institute of Pathology, Clinics of the Johannes Gutenberg-University, Mainz, Germany.
Virchows Arch. 1996 Feb;427(5):461-76. doi: 10.1007/BF00199506.
Major advances in intensive care medicine during the past two decades have altered the spectrum of disease encountered by intensive care physicians, anaesthesiologists, traumatologists and pathologists. One of the most important manifestations of severe trauma or infections is the multiple organ dysfunction syndrome (MODS), a life-threatening condition that often ends in multiple organ failure (MOF) and death. Evidence gathered from clinical and morphological observations in humans, taken together with experimental animal studies and a vast accumulation of in vitro data, clearly indicate that the microcirculation lies at the centre of this complex process, which results in peripheral vascular insufficiency, inadequate oxygen delivery to vital organs, and hence, severe organ dysfunction. The multifunctional nature of the endothelium makes it a prime candidate for study of the pathomechanisms of MODS. This paper reviews the evidence for the hypothesis that the microcirculation, and in particular its endothelial component, has a central role in the pathogenesis of MODS. The evidence is reviewed principally from the standpoints of classical morbid anatomy and cell pathobiology.
在过去二十年中，重症监护医学取得了重大进展，改变了重症监护医师、麻醉医师、创伤科医师和病理学家所面对的疾病谱。严重创伤或感染最重要的表现之一是多器官功能障碍综合征（MODS），这是一种危及生命的状况，常常以多器官衰竭（MOF）和死亡告终。从人体临床和形态学观察中收集的证据，结合实验动物研究以及大量体外数据，清楚地表明微循环处于这一复杂过程的核心位置，该过程会导致外周血管功能不全、向重要器官的氧输送不足，进而引发严重的器官功能障碍。内皮细胞的多功能特性使其成为研究MODS发病机制的主要对象。本文综述了微循环，尤其是其内皮成分在MODS发病机制中起核心作用这一假说的证据。主要从经典病理解剖学和细胞病理生物学的角度对证据进行了综述。
