全身炎癥和MODS認(rèn)識(shí)的變化及現(xiàn)狀(4)
5. 問題及展望
雖然近年對(duì)膿毒癥和MODS從認(rèn)識(shí)到治療均有新的進(jìn)展，但問題依然不少。膿毒癥和MODS的機(jī)理迄今仍未完全闡明，參與炎癥反應(yīng)介質(zhì)種類和其生物學(xué)活性、在病因?qū)W中的地位等仍在探討中；CARS等新假說目前還主要停留在理論上，需要實(shí)驗(yàn)和臨床研究的進(jìn)一步驗(yàn)證和完善；免疫調(diào)理治療看來是解決膿毒癥和MODS的根本途徑，但無論賴以指導(dǎo)治療的免疫學(xué)指標(biāo)還是糾正免疫紊亂的手段目前都還處在起步階段，而且十分有限；支持治療的各項(xiàng)改進(jìn)措施有許多還未獲確切的結(jié)論，即使已經(jīng)確切地顯示了積極效果的，與膿毒癥和MODS本身甚高的死亡率相比，還不能說已經(jīng)取得實(shí)質(zhì)性的突破；研究方法也需要改進(jìn)，統(tǒng)一用28天死亡率來作為異質(zhì)性很大的膿毒癥病人評(píng)判預(yù)后的標(biāo)準(zhǔn)是不恰當(dāng)?shù)�，�?yīng)該對(duì)不同原發(fā)病種進(jìn)行分類研究。還應(yīng)該對(duì)疾病的嚴(yán)重性進(jìn)行篩選，剔除病情明顯偏輕或過重而不可能從治療中真正受益的病例。在總結(jié)抗炎治療失敗的教訓(xùn)時(shí)，已故的美國(guó)學(xué)者Bone曾經(jīng)指出，不能指望僅靠一、二顆“魔彈”就能夠解決象膿毒癥和MODS這樣復(fù)雜的問題。因此，在繼續(xù)對(duì)各種單項(xiàng)治療進(jìn)行研究的同時(shí)，或許我們需要對(duì)綜合了各種新治療方法的病例行評(píng)估，才能夠更確切地反映當(dāng)前治療膿毒癥和MODS的完整能力。
, 百拇醫(yī)藥
參考文獻(xiàn)
1. Adrie C, Pinsky MR. The inflammatory balance in human sepsis. Intensive Care Med, 2000; 26:364-375.
2. Angus DC, Linde-Zwirble WT, Lidicker J, et al. Incidence, cost, outcome of severe sepsis in the United states. Crit Care Med, 2001(in press).
3. Bernard GR, Vincent JL, Laterre P-F, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. New Eng J Med, 2001, 344(10):699-709.
, 百拇醫(yī)藥
4. Bone RC. Sir Isaac Newton,sepsis, SIRS, and CARS. Crit Care Med, 1996; 24(7):1125-1128.
5. Bone RC. Immunologic Dissonance: A Continuing Evolution in Our Understanding of the Systemic Inflammatory Response Syndrome (SIRS) and the Multiple Organ Dysfunction Syndrome (MODS). Ann Intern Med, 1996; 125(8):680-687.
6. Hoffmann JN, Faist E. Removal of Mediators by Continuous Hemofiltration in Septic Patients. World J Surg, 2001; 25:651-659.
, 百拇醫(yī)藥
7. Kox WJ, Volk T, Kox SN, et al. Immunomodulatory therapies in sepsis. Intensive Care Ned, 2000; 26:S124-S128.
8. Reinhart K, Wiegand-Lohnert C, Grimminger F, et al. Asessment of the safety and efficacy of the monoclonal anti-tumor necrosis factor antibody-fragment, MAK 195F, in patients with sepsis and septic shock: a multicenter, randomized, placebo-controlled, dose-ranging study. Crit Care Med, 1996; 24:733-742.
9. Reinhart K, Menges T, Gardlund B, et al. Randomized, Placebo-Controlled Trial of the Anti-tumor Necrosis Factor Antibody Fragment Afelimomab in Hyperinflammatory Response During Severe Sepsis: The RAMSES Study. Crit Care Med. 2001; 29:765-769
, 百拇醫(yī)藥
10. Tsuneyoshi I, Yamada H, Kakihana Y, et al. Hemodynamic and metabolic effects of low-dose vasopressin infusions in vasodilatory septic shock. Crit care Med, 2001; 28:487-493.
11. Volk HD, Reinke P, Krausch D, et al. Monocyte deactivation-rationale for a new therapeutic strategy in sepsis. Intensive Care Med, 1996; 22:S474-S481.
12.Vincent J-L. Hemodynamic support in septic shock. Intensive Care Med, 2001; S80-S92., 百拇醫(yī)藥(林洪遠(yuǎn))
雖然近年對(duì)膿毒癥和MODS從認(rèn)識(shí)到治療均有新的進(jìn)展，但問題依然不少。膿毒癥和MODS的機(jī)理迄今仍未完全闡明，參與炎癥反應(yīng)介質(zhì)種類和其生物學(xué)活性、在病因?qū)W中的地位等仍在探討中；CARS等新假說目前還主要停留在理論上，需要實(shí)驗(yàn)和臨床研究的進(jìn)一步驗(yàn)證和完善；免疫調(diào)理治療看來是解決膿毒癥和MODS的根本途徑，但無論賴以指導(dǎo)治療的免疫學(xué)指標(biāo)還是糾正免疫紊亂的手段目前都還處在起步階段，而且十分有限；支持治療的各項(xiàng)改進(jìn)措施有許多還未獲確切的結(jié)論，即使已經(jīng)確切地顯示了積極效果的，與膿毒癥和MODS本身甚高的死亡率相比，還不能說已經(jīng)取得實(shí)質(zhì)性的突破；研究方法也需要改進(jìn)，統(tǒng)一用28天死亡率來作為異質(zhì)性很大的膿毒癥病人評(píng)判預(yù)后的標(biāo)準(zhǔn)是不恰當(dāng)?shù)�，�?yīng)該對(duì)不同原發(fā)病種進(jìn)行分類研究。還應(yīng)該對(duì)疾病的嚴(yán)重性進(jìn)行篩選，剔除病情明顯偏輕或過重而不可能從治療中真正受益的病例。在總結(jié)抗炎治療失敗的教訓(xùn)時(shí)，已故的美國(guó)學(xué)者Bone曾經(jīng)指出，不能指望僅靠一、二顆“魔彈”就能夠解決象膿毒癥和MODS這樣復(fù)雜的問題。因此，在繼續(xù)對(duì)各種單項(xiàng)治療進(jìn)行研究的同時(shí)，或許我們需要對(duì)綜合了各種新治療方法的病例行評(píng)估，才能夠更確切地反映當(dāng)前治療膿毒癥和MODS的完整能力。
, 百拇醫(yī)藥
參考文獻(xiàn)
1. Adrie C, Pinsky MR. The inflammatory balance in human sepsis. Intensive Care Med, 2000; 26:364-375.
2. Angus DC, Linde-Zwirble WT, Lidicker J, et al. Incidence, cost, outcome of severe sepsis in the United states. Crit Care Med, 2001(in press).
3. Bernard GR, Vincent JL, Laterre P-F, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. New Eng J Med, 2001, 344(10):699-709.
, 百拇醫(yī)藥
4. Bone RC. Sir Isaac Newton,sepsis, SIRS, and CARS. Crit Care Med, 1996; 24(7):1125-1128.
5. Bone RC. Immunologic Dissonance: A Continuing Evolution in Our Understanding of the Systemic Inflammatory Response Syndrome (SIRS) and the Multiple Organ Dysfunction Syndrome (MODS). Ann Intern Med, 1996; 125(8):680-687.
6. Hoffmann JN, Faist E. Removal of Mediators by Continuous Hemofiltration in Septic Patients. World J Surg, 2001; 25:651-659.
, 百拇醫(yī)藥
7. Kox WJ, Volk T, Kox SN, et al. Immunomodulatory therapies in sepsis. Intensive Care Ned, 2000; 26:S124-S128.
8. Reinhart K, Wiegand-Lohnert C, Grimminger F, et al. Asessment of the safety and efficacy of the monoclonal anti-tumor necrosis factor antibody-fragment, MAK 195F, in patients with sepsis and septic shock: a multicenter, randomized, placebo-controlled, dose-ranging study. Crit Care Med, 1996; 24:733-742.
9. Reinhart K, Menges T, Gardlund B, et al. Randomized, Placebo-Controlled Trial of the Anti-tumor Necrosis Factor Antibody Fragment Afelimomab in Hyperinflammatory Response During Severe Sepsis: The RAMSES Study. Crit Care Med. 2001; 29:765-769
, 百拇醫(yī)藥
10. Tsuneyoshi I, Yamada H, Kakihana Y, et al. Hemodynamic and metabolic effects of low-dose vasopressin infusions in vasodilatory septic shock. Crit care Med, 2001; 28:487-493.
11. Volk HD, Reinke P, Krausch D, et al. Monocyte deactivation-rationale for a new therapeutic strategy in sepsis. Intensive Care Med, 1996; 22:S474-S481.
12.Vincent J-L. Hemodynamic support in septic shock. Intensive Care Med, 2001; S80-S92., 百拇醫(yī)藥(林洪遠(yuǎn))
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