Boyd O, Bennett E D
Department of Anaesthesia, St. George's Hospital, London, UK.
New Horiz. 1996 Nov;4(4):453-65.
Multiple organ dysfunction syndrome (MODS) accounts for most surgical deaths which occur some days postoperatively. Current hypotheses concerning the pathophysiology of MODS place tissue hypoxia and reperfusion as a central feature of the initiation and continuation of the syndrome. Surgical patients are at risk of developing overt and covert tissue hypoxia and hypoperfusion due to anesthetic, surgical, and other factors; and it is known that surgical patients with poor cardiovascular reserve have a worse outcome postoperatively. A number of clinical studies have attempted to intervene early in surgical patients to prophylactically improve tissue perfusion in the perioperative period by augmentation of cardiac output. These studies demonstrate a reduction in mortality and morbidity in these groups of patients. A similar approach has been tried in other groups of critically ill patients, at a later state in the evolution of their illness; these studies have not shown any improvement in outcome. In surgical patients, data show that those with more coexisting pathology and worse cardiac function may benefit most from a treatment approach aimed at improving tissue perfusion; furthermore, this may result in cost savings. The implications for the management of the higher risk surgical patient are obvious. It may no longer be acceptable to undertake surgery in these patients without facilities to monitor and improve cardiac output and tissue perfusion.
多器官功能障碍综合征（MODS）是术后数天内大多数外科手术死亡的原因。目前关于MODS病理生理学的假说认为组织缺氧和再灌注是该综合征发生和持续的核心特征。由于麻醉、手术及其他因素，外科手术患者存在发生显性和隐性组织缺氧及灌注不足的风险；而且已知心血管储备功能差的外科手术患者术后预后更差。一些临床研究试图在外科手术患者早期进行干预，通过增加心输出量来预防性改善围手术期的组织灌注。这些研究表明这些患者组的死亡率和发病率有所降低。在其他危重症患者群体中，在疾病发展的后期也尝试了类似的方法；但这些研究并未显示出预后有任何改善。在外科手术患者中，数据表明合并症更多且心功能更差的患者可能从旨在改善组织灌注的治疗方法中获益最大；此外，这可能会节省成本。对于高风险外科手术患者的管理而言，其意义显而易见。在没有监测和改善心输出量及组织灌注设施的情况下，对这些患者进行手术可能不再被接受。
