ｂａｃｔｅｒｉａｌ　ｔｒａｎｓｌｏｃａｔｉｏｎの診断と治療　　ＭＯＦにおけるｂａｃｔｅｒｉａｌ　ｔｒａｎｓｌｏｃａｔｉｏｎの実態とその対策

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 23; no. 3; pp. 491 - 497
• Main Authors: Oda Shigeto, Hirasawa Hiroyuki, Shiga Hidetoshi, Nakanishi Kazuya, Matsuda Kenichi, Nakamura Masataka
• Format: Journal Article
• Language: Japanese
• Published: 日本腹部救急医学会 2003; Japanese Society for Abdominal Emergency Medicine
• Subjects: bacterial translocation (BT); 多臓器不全 (MOF); 経腸栄養 (EN); 選択的腸管内除菌 (SDD)
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem1993.23.491

Bacterial translocation (BT) has recently gained attention as an important factor in the onset and deterioration of multiple organ failure (MOF). The morbidity of clinically identified BT in MOF patients was 10.5%, and the survival rate of MOF patients with BT was significantly lower than in MOF patients without BT in our study. Although an early clinical diagnosis of BT is difficult to achieve, the ratio of the interleukin-6 (IL-6) level in the pulmonary arterial blood and the arterial blood (PA/A) as measured using a rapid chemiluminescent enzyme immunoassay (CLEIA) system could be a new diagnostic tool for the early diagnosis of BT. Selective digestive decontamination (SDD) has been widely applied and evaluated as a countermeasure against BT. We performed SDD and early enteral nutrition (EN) in patients with MOF. SDD and EN reduced the infection rate after ICU admission and improved the survival rate of MOF patients with infections complications. Since BT plays an important role in the pathophysiology of MOF, early diagnosis and the early application of SDD and EN are important for the management of patients with a high risk of BT. 多臓器不全 (MOF) の発症. 増悪因子の一つとしてbacterial translocation (BT) が注目されている. われわれの検討では, MOF症例の10.5%が臨床的にBTと考えられる症例であり, BT合併MOF症例の救命率は24.3%と, 非合併例に比し有意に低かった. 臨床例においてBTを早期に診断するのは困難であるが, IL.6迅速測定法によるIL-6血中濃度の肺動脈血/動脈血比 (PA/A) がBTの早期診断に有用である可能性が示唆された.BTに対する対策として以前より選択的腸管内除菌 (SDD) の効果が検討されている. われわれはBT対策としてSDDと早期よりの経腸栄養 (EN) を積極的に施行している. その結果, MOF症例の新たな感染症発症率が低下し, 感染症合併MOF症例の救命率は有意に改善した. BTは, MOF発症・増悪に深く関与しておりBT症例の予後は不良であることから, BTを早期に診断しhighrisk症例に対してはSDD, ENを積極的に施行することが重要であると考えられた.