Grotz M, Regel G, Bastian L, Weimann A, Neuhoff K, Stalp M, Tscherne H
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Zentralbl Chir. 1998;123(3):205-17.
Multiple organ failure is with an incidence of 10-25% and a mortality of 50-70% the most severe complication after severe trauma. Intestinal ischemia and a corresponding impaired gut barrier function is thought to have a high impact on the development of multiple organ failure after severe trauma. Under normal conditions the intestinal wall is a sufficient barrier against bacteria and their products. Gut ischemia is followed by mucosal lesions, the intestinal permeability is increased. Translocating bacteria and bacterial products (endotoxin, peptidoglykan) can lead to a local and/or systemic immun-inflammatory response, which is made responsible for the development of multiple organ failure. Tonometry as a possibility of monitoring intestinal ischemia as well as a tool to estimate the prognosis of multiple trauma patients is still discussed controversially. Dopexamin, which directly influences intestinal ischemia (goal directed therapy) might be a successful treatment option, however until now no clinical study about beneficial effects of dopexamine in severely injured patients is available. Selective gut decontamination showed no clinical benefits in multiple trauma patients. Early enteral nutrition especially with immunomodulating ingredients ("immunonutrition") decreases posttraumatic complications as well as the incidence of MOF. However a reduction of mortality could not be described in severely injured patients so far.
多器官功能衰竭是严重创伤后最严重的并发症，发病率为10% - 25%，死亡率为50% - 70%。肠道缺血及相应的肠屏障功能受损被认为对严重创伤后多器官功能衰竭的发生发展有很大影响。在正常情况下，肠壁是抵御细菌及其产物的有效屏障。肠道缺血后会出现黏膜损伤，肠道通透性增加。细菌及细菌产物（内毒素、肽聚糖）移位可导致局部和/或全身免疫炎症反应，这被认为是多器官功能衰竭发生的原因。作为监测肠道缺血的一种方法以及评估多发伤患者预后的工具，张力测定法仍存在争议。多培沙明可直接影响肠道缺血（目标导向治疗），可能是一种成功的治疗选择，但目前尚无关于多培沙明对重伤患者有益作用的临床研究。选择性肠道去污在多发伤患者中未显示出临床益处。早期肠内营养，尤其是含有免疫调节成分的“免疫营养”，可减少创伤后并发症以及多器官功能衰竭的发生率。然而，迄今为止，在重伤患者中尚未发现死亡率有所降低。
