小儿危重病人MMDS的识别与防治-曾其毅..PPT

四、MMDS的治疗 3、重组活化蛋白C（rhAPC） 生理作用：内生的APC具有抗血栓、抗炎和调理内皮细胞功能等作用，在调节脓毒症时的凝血反应和炎症反应平衡中发挥重要作用。 已有大量临床试验，使用rhAPC诱导治疗脓毒症，证实rhAPC显著的抗炎和抗凋亡作用，能有效改善微循环，提高伴有感染性休克或器官功能障碍ICU患者的生存率。 五、展望 微循环和线粒体功能障碍与脓毒症多器官功能衰竭间存在因果关系。 及时的液体复苏及有针对性的治疗可以限制炎症反应，改善器官功能障碍，提高患者生存率。 未来的研究重点：阐明不同治疗方案与微循环和线粒体功能之间的相互作用，并进行大量临床试验以明确治疗方案及其疗效。 谢 谢！ * In most cases, focal infections are eradicated by an intense, localized inflammatory response. ‘Collateral damage’ to regional tissues does occur and is repaired after the infection and associated inflammation subside. By contrast, severe sepsis is characterized by dissemination of inflammatory mediators (e.g. circulating cytokines) resulting in widespread activation of the immune system distal to the original site of infection, the clinical manifestations of which are commonly referred to as the systemic inflammatory response syndrome (SIRS). SIRS is often complicated by systemic hypotension and tissue hypoperfusion (shock), and direct (e.g. TNFa-mediated) cell injury, which ultimately leads to multiple organ dysfunction syndrome (MODS), and in many cases death. * Sepsis is a disorder of the microcirculation. Much of the pathophysiology of sepsis can be explained within the microcirculatory unit—the terminal arteriole, the capillary bed, and the postcapillary venule. The arteriole is where the characteristic vasodilation and vasopressor hyporesponsiveness of sepsis occurs. The capillary bed is where the effects of endothelial cell activation/dysfunction are most pronounced and microvascular thromboses are formed. The postcapillary venule is where leukocyte trafficking is most disordered—leukocytes adhere to the vessel wall, aggregate, and further impair flow through the microcirculation. (From Trzeciak S, Cinel I, Phillip Dellinger R, et al. Resuscitating the microcirculation in sepsis: the central role of nitric oxide, emerging concepts for novel therapies, and challenges for clinical trials. Acad Emerg Med 2008;15:399–413; with permission.) * 小儿危重病人