对多系统器官衰竭的概念、诊断和命名的初议

A COMMENT ON THE CONCEPT AND DIAGNOSIS OF MULTIPLE SYSTEM ORGAN FAILURE

提出多系统器官衰竭(MSOF)的问题已有20年的历史,但迄今对其概念和诊断还存在相当的混乱,反映了人们对这一问题认识的巨大差距。作者认为,应当从机体失控的炎症反应而导致器官损伤这一基本病理特征来理解MSOF的本质,并应将脓毒反应这个炎症的突出表现加入到诊断标准中,以确保对MSOF诊断的准确性。由于器官衰竭只是这个失控的炎症一连串病理过程的终结,将器官衰竭诊断标准用于这个病症,既不能反映其全貌也不利于早期诊断和治疗,因此,作者提出用“器官功能不全”取代“器官衰竭”作为该病症的诊断标准。最后,作者认为“MSOF”的命名应予改变,以适应我们对其日益加深的了解。

Since the emergence of the new syndrome, termed multiple system organ failure (MSOF), about two decades age, it has aroused an outburst of enthusiasm in clinical and experimental studies among many clinicians and investigators both abroad and at home. Nevertheless, it has also created much confusion in the concept as well as the diagnosis of the syndrome, mainly because the present term does not clearly differentiate this syndrome from some other irrelevant clinical conditions, such as senile dysfunction of multiple organs, agonal state etc. As it has been documented to occur almost as a rule after a septic state and also under the intricate interaction of many humoral and cellular mediators, we suggest that the diagnosis of MSOF should at least include two concurrent conditions, i. e. septic response and organ failure.Inasmuch as the present diagnosis of MSOF designates only the terminal state of a series of pat-hophysiological process, namely systemic inflammatory response---sepsis--septic syndrome--MSOF,it is not conducive to an early diagnosis, which is of utmost importance in the prevention and early treatment of this frequently fatal syndrome. In the light of current investigations, we propose that the name of the syndrome be changed to 'sepsis and organ dysfunction' or 'mediator injury of organs*. Our humble opinion welcomes further comments and discussion.