3.mods09多器官功能衰竭

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1、多器官功能障碍综合征(multipleorgandysfunctionsyndrome,MODS)中山大学附属一院急诊科李玉杰目的1.掌握SIRS、sepsis、MODS的概念2.熟悉SIRS的诊断标准3.了解：SIRS的发病机制、治疗原则sepsis的病理生理、诊断、治疗原则MODS的发病机制、诊断、治疗原则4.自学：其他内容第一节全身炎症反应综合征(systemicinflammatoryresponsesyndrome,SIRS)SIRS（1）定义机体对致病因子的过度应激反应，引起炎症性损伤的综合征病因感染病原

2、生物非感染所有损害机体健康的事件SIRS（2）发病机制炎症细胞（单核-巨噬细胞等）的激活，促进释放炎症介质（TNF-α,IL-1β;IL-6,IL-8,PAF,NO），引发免疫功能失调（炎症/抗炎失衡）和生理功能紊乱（血管、血液成分、酶等）SIRS（3）发展阶段局部反应期全身炎症反应始动期全身炎症反应期过度免疫抑制期免疫功能紊乱期SIRS（4）诊断1.体温T>38℃/<36℃2.心率HR>90bpm3.呼吸R>20bpm/PaCO2<4.3kPa(32mmHg)4.白细胞WBC>12×109/L/<4.0×109/L

3、/不成熟WBC>10%符合2项或以上ACCP/SCCM1991SIRS（5）诊断标准*敏感性高，特异性低（假阳性）*结合其他评分系统*预警作用earlyrecognitionEffectivetreatmentrequiresearlyrecognitionofSIRS—andthebestwaytocatchthesyndromeinitsearlystagesistoidentifypatientswhoaremostatriskfordevelopingit.Theyinclude:*veryyoungandv

4、eryoldpatients*malnourishedorimmunocompromisedpatients*patientswhohaveinvasivecatheters*patientswithpreexistingchronicdisease*criticallyillorcriticallyinjuredpatients*patientsonlong-termsteroidmedicationsorantibiotics*patientswhoarecomatosewhenadmitted.SIRS（6）治

5、疗原则去除诱因治疗病因拮抗炎症介质单抗、拮抗剂、清除恢复免疫平衡对症支持中医中药第二节脓毒症/病(sepsis)Sepsis(1)定义Thepresenceofpathogenicmicro-organismsortheirtoxinsintissuesorintheblood.Systemicdiseasecausedbythespreadofthemicroorganismsviathecirculatingbloodiscommonlycalledsepticemia(败血症/病).sepsis=SIRS（感染

6、性病原生物）SEPSISISSERIOUSBUSINESSIn2003,septicemia—atypeofsepsis—rankedasthe10thleadingcauseofdeathintheUnitedStates.About750,000patientsarediagnosedwithsepsiseachyear,andit'stheleadingcauseofnoncardiacdeathsinintensivecareunits.Despiteintensiveresearcheffortstodev

7、elopeffectivetreatments,thesepsismortalityratehasn'tdeclined:28%to50%ofpatientswhodevelopsepsisdie.Notonlyistheconditionphysicallydevastatingforpatients,butitalsoplacesanenormousstrainonthehealthcaresystem.Theannualcostfortreatingsepsisisastaggering$16billionto

8、$17billion—approximately$22,000persepsispatient.SepsisSepsiscanbedescribedasastepalongacontinuumthatbeginswithageneralizedinflammatoryresponsetoatrigger.Theprogressionfromin