Kes P
Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Zagreb, Croatia.
Acta Med Croatica. 1998;52(2):127-32.
Endotoxic shock with multiorgan dysfunction syndrome (MODS) is fatal in more than 80% of cases and is the leading cause of death in patients admitted to intensive care units. The incidence has increased to more then 100% in the last 10 years and there has been no significant decreases in its morbidity and mortality. The systemic inflammatory response to infection, e.g. sepsis, develops when the endotoxins activate various cascade systems. The activation of the cascade systems triggers further release of various active substances and cytokines. The progress may result in consumption coagulopathy, which may further generate an acute septic shock, disseminated intravascular coagulation, and MODS. When more than 3 organs are involved, the risk of fatal outcome exceeds 80%. The use of plasma exchange may be a beneficial adjunct to therapy during a progressive septic shock with MODS, when the patient does not respond to classical intensive care unit therapy. The beneficial effect, recently reported for plasma exchange procedures in patients with sepsis, may be due to the removal of various toxins and waste products from the blood, and administration of plasma from healthy subjects.
伴有多器官功能障碍综合征（MODS）的内毒素休克在80%以上的病例中是致命的，并且是重症监护病房收治患者的主要死因。在过去10年中，其发病率已增至100%以上，发病率和死亡率并未显著下降。当内毒素激活各种级联系统时，会引发对感染（如败血症）的全身炎症反应。级联系统的激活会触发各种活性物质和细胞因子的进一步释放。这一过程可能导致消耗性凝血病，进而可能引发急性感染性休克、弥散性血管内凝血和多器官功能障碍综合征。当涉及3个以上器官时，致命结局的风险超过80%。在进展性感染性休克合并多器官功能障碍综合征且患者对传统重症监护病房治疗无反应时，血浆置换可能是一种有益的辅助治疗方法。最近报道的血浆置换程序对败血症患者的有益效果，可能是由于从血液中清除了各种毒素和废物，并输入了健康受试者的血浆。
