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題名 | Pathogenetic Role of Gut in Irreversible Hemorrhagic Shock=腸子在不可逆出血性休克時扮演之病原學角色 |
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作者 | 張財旺; 吳明和; Chang, Tsai-wang; Wu, Ming-ho; |
期刊 | 中華民國急救加護醫學會雜誌 |
出版日期 | 19970900 |
卷期 | 8:3 1997.09[民86.09] |
頁次 | 頁103-112 |
分類號 | 416.123 |
語文 | eng |
關鍵詞 | 腸道; 不可逆休克; 出血性休克; Intestine; Irreversible shock; Hemorrhagic shock; |
中文摘要 | 在本文中,作者對於腸道在不可逆出血性休克時扮演之病原學角色進行討論並回顧相關文獻。出血性休克是外傷病息的主要致死原因;嚴重的出血可能引姿不可逆休克,因此即使將血容量回複,仍會造成死亡。不可逆休克之原因仍不清楚,但以下的證據顯示腸道可能扮有相關病原學之角色:(1)腸子缺血的狀況會引發不可逆休克;(2)休克時若腸子闕如,可避免實驗姿生不可逆休克而引起之死亡。在文獻上,不可逆休克可被歸因於一些在出血性動物實驗時發現之現象,包括肝內ATP含量不足。在出血性休克發生後,肝內ATP之存量,與其他器官相較,呈最大幅度之下降而且其下峰幅度與不可逆休克之發生有相關。最近作者的研究顯示腸子可能同時涉及肝內ATP下降及休克致死之過程,這項結果暗示為腸子有關之肝臟能量代謝異敘或許與不可逆休克之姿生有關。作者認為進一步研究腸子在出血性休克時對於肝臟能量代謝之影響將有助於我們瞭解不可逆出血性休克之機轉。 |
英文摘要 | In this article, we have attempted to address the pathogenetic role of the gut in irreversible of hemorrhagic shock. Hemorrhagic shock is a major cause of death in patients with trauma. Severe hemorrhagic shock can progress to an irreversible state leading to death even after circulation is restored, as first described by Wiggers Harold. Mechanisms for irreversible shock remain unclear, however, experimental data have strongly implicated a pathogenetic role for the gut in irreversible shock as supported by the following: (1) intestinal ischemia by itself provokes irreversible shock; and (2) removal of the intestines or avoidance of intestinal ischemia during shock protects animals from irreversibility. In the literature, irreversible shock has been attributed to a number of alterations observed in hemorrhagic shock animal models, including the depletion of hepatic adenosine triphosphate (ATP) levels. After the induction of hemorrhagic shock, many organs are associated with decreased ATP levels, but the liver, among the various organs studied, was noted to have its ATP reserves depleted the most dramatically and correlated most reliably with the decompensatory phase of shock. Recent studies have shown that the intestines are involved in the process leading to both the depletion of hepatic ATP and irreversible shock, suggesting a causal relationship between the gut-related energy insufficiency of the liver during hemorrhagic shock and the occurrence of irreversible shock. Continued research to investigate the intestinal effect on hepatic energy metabolism during hemorrhagic hypotension may help us better understand the mechanisms of irreversible hemorrhagic shock. |
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