多脏器功能障碍合征及监护.ppt

多脏器功能障碍综合征及监护 Denomination variation 1973 secondary system function failure--- Tilney Summary data of 18 cases ARF patients after abdominal aortic aneurysm operation,and 17 patients died from organ failure during dialysis . 1975－1977 MOFS，multiple organ failure syndrome-----Baue，1975 （Yet the treatment did not save the lives.) MOF ，multiple organ failure----- Eiseman，1977 1980‘s MSOF，multiple system organ failure----- Fry38/533 point out the relationship between MSOF and severe infection 1990‘s ※MODS,multiple organ dysfunction syndrome※ MODS followed by primary emergency disease in 24 hours Clinical manifestation burst out Simultaneous die quickly primary MODS Ischemia ischemia and reperfusion physical and chemical injury factor Sequential organ dysfunction after emergency disease,MODS Clinical behavior Delayed Sequential Reversible MODS Excessive inflammatory mediators 1.Direct injury of ischemia Hypersensibitity in heart and brain Selective ischemia Endothelial cell injury leads to high vascular permeability and low volume uncontrolled stress 2.Differentiation Diagnosis with prerenal ARF Treatmen of ARDS Maintain Circulation and lung interstitial edema Proper crystal/colloid rate Diuretic Negative water balance (according to CVP/PAWP , urine output and lung auscultation) Treatmen of ARDS Prevent and treat infection Block SIRS corticoid in the initial stage mediators inhibitor (Ibuprofen, Dentoxifylline,TNF antibody) Treatment of ARF correct electrolytes imbala Hyperkalemia Hyponatremia Hypocalcemia Acidosis Counterinfection blood purification (CHF) Influenced organ Lung ——ARDS >95% Kidney—— ARF only a few Acute Respiratory Distress Syndrome, ARDS Pathology of lung High capillary permeability——Interstitial edema Vasoconstriction,micro thrombosis ——communicating branch opening Alveolar and small bronchus——Atelectasis Decreased alveolar surfactant Edema I type epithelial cel