急性呼吸窘迫综合征及多器官功能衰竭.pptVIP

病 因 吞噬细胞激活 TNFα、C5a IL-1、IL-6 内皮细胞、 ICAM-1表达 促进WBC粘附聚集、激活 血管内皮受损微血栓形成，通透性 ↑ 释放炎症介质 细胞因子,自由基、 溶酶体酶 器官功能障碍 （MODS） ICAM-1 ：细胞黏附分子 MODS病理生理 Infection/Injury 宿主反应 SIRS CARS MODS 未控制的 炎症反应 过度 适当 Death 不适当 控制的 炎症反应 表1. MODS的初步诊断 器官 病症 临床表现 检测或监测 心 外周 循环 肺 肾 急性心力衰竭 休克 ARDS ARF 心动过速，心律失常 无血容量不足的情况 下血压降低，肢端发凉，尿少 呼吸加快、窘迫，发 绀，需吸氧和辅助呼 吸 无血容量不足的情况 下尿少 心电图失常 平均动脉压降 低，微循环失常 血气分析有血 氧降低等，监 测呼吸功能失常 尿比重持续在1.010±，尿 钠、血肌酐增 多 续表1. MODS的初步诊断 器官 病症 临床表现 检测或监测 胃肠 肝 脑 凝血 功能 应激性溃疡 肠麻痹 急性肝衰竭 急性中枢神经 功能衰竭 DIC 进展时呕血、便血 腹胀，肠鸣音弱 进展时呈黄疸， 神志失常、意识障碍，对语言、疼痛刺激等反应减退 进展时有皮下出血 瘀斑、呕血、咯血 等 胃镜检查见病变 化验肝功能失常， 血胆红素增多 血小板减少，凝血酶原时间和部分凝血活酶时间延长，其他凝血功能试验也可失常 治 疗 治疗原则 病因及诱因治疗； 一般支持治疗； 对症治疗； 其他重要脏器功能的监测与支持； 复习思考题 急性呼吸窘迫综合征的概念 急性呼吸窘迫综合征的治疗 * Finally, let us have a short summary about what we have studied this time. We know MODS is a kind of emergent clinical syndrome. It involves the dysfunction of two or more organs. It develops in very short time. MODS can be caused by both infective and noninfective diseases. Whatever the reason is, the clinical manifestations of these two types are not different. So we pay much attention on the common mechanisms of MODS. Uncontrolled inflammatory response is the most important factor to trigger MODS. In some of the patient, this uncontrolled inflammatory response may be presented as overregulated pro-inflammatory response. So, we can observe the disseminated pro-inflammatory mediators in the circulation. Some of the mediators are harmful to the body tissues, such as TNF-a, Free radical. That is the reason why these distant organs can receive the signal and become failure. We call this phenomena as systemic inflammatory response syndrome. The other type is compensatory anti-inflammatory response syndrome. The patients have overexpressioned anti-inflammatory mediators so they cannot confront with the m