陶晓根讲义120141031案例分析.ppt

 Acute Gastrointestinal Injury in the ICU  安徽省立医院ICU 陶晓根 概 念 名称和含义不一样 Gut Failure Gas trointestinal Disfunction Gut Disfunction Gastrointestinal Failure Acute intestinal failure Acute intestinal Disfunction ……….. 概 念 概 念 Methods: 回顾性研究 ，n = 2588 3 ICUs 2002年 GIF 定义： (food intolerance, gastrointestinal haemorrhage, and/or ileus) in the patient data at any period of their ICU stay. Incidence, characteristics and outcome of gastrointestinal failure (GIF) in intensive care patients. 病人来源于紧急手术或内科病人，APACHEⅡ和SOFA评分、入院时儿茶酚胺类物质的使用被确定为GIF的独立危险因素。 住ICU期间的发生GIF是死亡的独立预测因素 Markers of gut dysfunction in critical illness Feeding intolerance was a subjective measurement intraabdominal hypertension was not specific to gut failure GIF评分不足 将IAP仅分作IAH和ACS两档看来过于简单，需要细分的必要 细菌毒素移位和由此引发的炎症反应是GIF重要的病理变化和组分，如何在评分中得到反映值得探讨 概 念 概 念 概 念 概 念 概 念 133 patients 83 cases (62.4%) with AGI and 50 cases (37.6%) without AGI. AGI grade I ：38 cases (45.8%), AGI grade II ：33 cases (39.8%) , AGI grade III ：8 cases (9.6%) , AGI grade IV 4 cases (4.8%) . The major causes of AGI shock (15 cases), severe sepsis (15 cases), severe pneumonia accompanied by respiratory failure (14 cases), open surgery (9 cases), severe acute pancreatitis (8 cases), severe craniocerebral trauma (8 cases), cardiac arrest (5 cases), multiple trauma (5 cases), and drug poisoning (4 cases). Comparison of prognosis between AGI group and NO-AGI group AGI 严重程度分级 AGI 严重程度分级 AGI 严重程度分级 AGI 严重程度分级 AGI 严重程度分级 AGI 严重程度分级 AGI 严重程度分级 AGI 严重程度分级 GUT PATHOPHYSIOLOGY: THE ACTORS 上皮细胞 黏膜免疫系统 肠道菌群 激素 肠神经系统 GUT PATHOPHYSIOLOGY: THE ACTORS GUT PATHOPHYSIOLOGY: THE ACTORS 发病机制 The Gut Origin of Sepsis Hypothesis The ‘‘Three Hit Model’’ Theory The ‘‘Gut-Lymph’’ Theory Intestinal Crosstalk The gut hypothesis for the pathogenesis of critical illness Crosstalk between the intestinal epithelium, immune system, commensal bacteria, enteric nervous system, and hormones. 细菌易位 (1) gut-origin bacteria or endotoxins found in the mes