《基础医学各论3》资料：MODS 2013.ppt

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1、MultipleOrganDysfunctionSyndrome(MODS)JianzhongShengMD,PhDDepartmentofPathophysiologySchoolofMedicineZhejiangUniversityDefinitionDysfunctionorfailureofmultipleorganorsystemhappenedsimultaneouslyorsequentiallyduetovariousetiologicalfactors.EtiologyInfection:Grampositive/negative

2、bacteria,fungal,VirusShock:hemorrhage,etc.AllergyBurnsTraumaSevereacutepancreatitisClassificationofMODSImmediateType(Primary)：Dysfunctionarehappenedsimultaneouslyintwoormoreorgansduetoprimarydisease.Delayedtype(Secondary）：Dysfunctionhappenedinaorgan,otherorganssequentiallyhappe

3、neddysfunctionorfailure.Accumulationtype：Dysfunctionleadedbychronicdisease.AttentionImmediateTypeNotrelatedtoSIRSCoupinjurywithchemicalorphysicalfactorsNotimeintervalfromdiseaseARDS+ARForARDS+ARF+DIC+LFDelayedtypeNotthedirectoutcomefrominjuryRelatingtoSIRS（systemicinflammatoryr

4、esponsesyndrome）TimeintervalexistedfromprimarydiseaseAccumulationtypeAccumulationIrreversibleARDS:acuterespiratorydistresssyndromeARF:acuterenalfailureLF:liverfailureMechanismInflammatorymediatorsprimingSIRSleadingtoMODSVascularpermeability↑＋PMNchemotaxisMono/MacrophagePMNelast

5、asePLA2oxygenfreeradicalsTNFIL－8IL－1IL－6Liver：acutephaseRemoteorganinjuryTissueinjuryEndotheliumInjuryfactorsPMNPAFAdhensivemoleculesDICpolymorphonucleocytePAF,plateletactivatingfactorCommonManifestationsofMODSOrganSymptomsHeartAcuteheartfailurePeripheralcirculationShockLungALI

6、/ARDSKidneyARFGastro-intestineStressulcer/enteroparalysisLiverAcutehepaticfailureBrainCNSfailureCoagulationDICDiagnosisofCriteriaOrgan/systemdysfunctionandfailureGLASGOWSCORETreatmentsofMODSCombinedtherapyCorrectionofischemia:fluidresuscitation,mechanicalventilationPreventionof

7、infection：drainage,antibioticsInterruptionofpathologicalreaction：hemofiltrationStabilizationofinternalenvironment：water,electrolyte,acid-baseimbalanceRegulationofimmunity：cellularandhumorSupportoforganfunctionVentilatorArtificialkidneyArtificialliverProtectionofenteralmucosaDru

8、gsofprotectionofheartThanks!