多脏器功能障碍综合征和监护

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1、多脏器功能障碍综合征及监护MODSandintensivecareDenominationvariation1973secondarysystemfunctionfailure---TilneySummarydataof18casesARFpatientsafterabdominalaorticaneurysmoperation,and17patientsdiedfromorganfailureduringdialysis.1975－1977MOFS，multipleorganfailuresyndrome-----Baue，1975（Yetthetreatmentdidnot

2、savethelives.)MOF，multipleorganfailure-----Eiseman，19771980‘sMSOF，multiplesystemorganfailure-----Fry38/533pointouttherelationshipbetweenMSOFandsevereinfection1990‘s※MODS,multipleorgandysfunctionsyndrome※2Case1Male26yPost-subtotalexcisionofcolonIleocolonicstomaleakageMultipleintestinalfistula

3、3Abdominalabscess4Long-termapplicationofhighcaloriaparenteralnutrition(fatemulsion)livertumefactionliverdysfunctionSGPT36SGOT144TB167.9DB102.85HR170RR55PaCO223.8WBC18700Positivebloodcultivation6Jan16thsepticshockJan17thRenalfunctionBUN20.5Cr337needinhalationofoxygenwithmaskcontinuoushemofilt

4、rationJan19thtracheotomyventilatorapplication7Case2male59yExtensiveanteriorwallMyocardialinfarction20daysafteronset(2002/3/6)continuousventriculartachycardia→ventricularfibrillationelectricdefibrillation5timesantiarrhythmicdrugscountershockdrugsventilatorapplication8HR120RR28PaCO226.8WBC1260

5、09Repeatedlyventriculartachycardiaandfibrillation，totally21timeselectricdefibrillationContinuoushyperpyrexia、highWBC、HR≥90、RR≥22Cultivationnegative,antibioticsnoeffectivenessOrgandysfunctioncameincrowdsshockRespiratorydysfunctionDeteriorationofliverfunctionCastinurineroutinetest→BUN、Cr↑→olig

6、uria、anuriaCoagulationabnormalitydeath10AcuteonsetManifestatinofexcessiveinflammationDeteriotationofpts’conditionsdespiteactivetherapyMultipleorgandysfunctionDifferentpts,SameprogressCase1:infectiousCase2:noninfectious11clinicalbehaviorAccumulativeSubstanceirreversibleMultipleorganlowfunctio

7、ncausedbyinteractionbetweenorgansChronicdiseaseMultipleorganlowfunction12MODSfollowedbyprimaryemergencydiseasein24hoursClinicalmanifestationburstoutSimultaneousdiequicklyprimaryMODSIschemiaischemiaandreperfusionphysicalandchemicalinjuryfactor13Sequ