Zusammenfassung
Störungen der Mikrozirkulation sind für die Manifestation des Organschadens nach Ischämie/Reperfusion und Endotoxinämie/Sepsis von entscheidender Bedeutung. Insbesonders werden heute die Persistenz nutritiver Perfusionsstörungen mit fokaler Minderperfusion und Hypoxie vitaler Organe, einschließlich der Leber, sowie die Aktivierung zellulärer und humoraler Systeme sowohl für die Entwicklung als auch für die Progredienz des multiplen Organversagens als ursächliche Mechanismen diskutiert. Kausal wirksame Strategien zur Protektion der Leber bei Ischämie/Reperfusion und Endotoxinämie/Sepsis verlangen daher detaillierte Kenntnisse über mikrohämodynamische, zelluläre und molekulare Mechanismen, welche zur Gewebeschädigung fuhren bzw. diese vermitteln. In vivo-Untersuchungen der hepatischen Mikrozirkulation mittels Fluoreszenzmikroskopie erlauben aufgrund der simultanen Erfassung von nutritiver Perfusion, Zell-Zell-Interaktion, Zellfunktion und - integrität aus in vitro-Untersuchungen erzielte Ergebnisse hinsichtlich ihrer funktionellen Bedeutung für die Manifestation des Gewebeschadens zu überprüfen. Inwieweit die im Experiment nachgewiesene Effektivität dieser therapeutischen Interventionen für die Klinik Gültigkeit hat, muß in prospektiv randomisierten Studien geprüft werden.
Summary
Microcirculatory disturbances play a pivotal role for the manifestation of organ injury following ischemia/reperfusion and endotoxemia/sepsis. Persistence of nutritive perfusion failure, local ischemia and hypoxia of vital organs, including the liver, as well as the activation of cellular and humoral systems are considered as causative mechanisms for both the initiation and the propagation of multiple organ failure. Therapeutic strategies aiming at protection of liver tissue should be based upon detailed information on microvascular, cellular and molecular mechanisms leading to organ damage. Simultaneous assessment of nutritive perfusion, cell-cell interaction, parenchymal cell function and integrity by means of In vivo fluorescence microscopy of the hepatic microcirculation allows to prove the functional role of proposed mechanisms deduced from in vitro studies. Final efffectiveness of experimentally proved therapeutic regimen has to be analyzed in subsequent randomized, prospective clinical trials.
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Vollmar, B. (2000). Bedeutung der Leukozyten-Endothelzell- Interaktion für die Manifestation der Leberfunktionsstörung nach Ischämie/Reperfusion und Endotoxinämie. In: Schöffl, H., et al. Forschung ohne Tierversuche 2000. Ersatz- und Ergänzungsmethoden zu Tierversuchen. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6760-1_43
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DOI: https://doi.org/10.1007/978-3-7091-6760-1_43
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