血液循环障碍MODS 2010.pptVIP

Multiple Organ Dysfunction Syndrome (MODS) Jianzhong Sheng MD, PhD Department of Pathophysiology School of Medicine Zhejiang University Definition Dysfunction or failure of multiple organ or system happened simultaneously or sequentially due to various etiological factors. Etiology Infection: Gram positive/negative bacteria, fungal, Virus Shock :hemorrhage, etc. Allergy Burns Trauma Severe acute pancreatitis Classification of MODS Immediate Type (Primary)：Dysfunction are happened simultaneously in two or more organs due to primary disease. Delayed type (Secondary）：Dysfunction happened in a organ, other organs sequentially happened dysfunction or failure. Accumulation type：Dysfunction leaded by chronic disease. Attention Immediate Type Not related to SIRS Coup injury with chemical or physical factors No time interval from disease ARDS+ARF or ARDS+ARF+DIC+LF Delayed type Not the direct outcome from injury Relating to SIRS（systemic inflammatory response syndrome） Time interval existed from primary disease Mechanism Common Manifestations of MODS Diagnosis of Criteria GLASGOW SCORE Treatments of MODS Combined therapy Correction of ischemia: fluid resuscitation, mechanical ventilation Prevention of infection：drainage, antibiotics Interruption of pathological reaction：hemofiltration Stabilization of internal environment：water, electrolyte, acid-base imbalance Regulation of immunity：cellular and humor Support of organ function Ventilator Artificial kidney Artificial liver Protection of enteral mucosa Drugs of protection of heart Thanks! Acute Renal Failure (ARF) Definition Characterized by ineffective filtration across glomeruli in short time. Such as azotemia, imbalance of water, electrolyte and acid-base. Etiology and classification Prerenal Proximal to kidney Decrease in renovascular flow Hypovolemia, severe cardiac dysfunction, loss of vascular tone, drugs (renal vasoconstriction), renal artery occlusion Abdominal Compartme