多脏器功能障碍综合征及监护.ppt

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

2、me-----Baue，1975（Yetthetreatmentdidnotsavethelives.)MOF，multipleorganfailure-----Eiseman，19771980‘sMSOF，multiplesystemorganfailure-----Fry38/533pointouttherelationshipbetweenMSOFandsevereinfection1990‘s※MODS,multipleorgandysfunctionsyndrome※2Case1Male26y

3、Post-subtotalexcisionofcolonIleocolonicstomaleakageMultipleintestinalfistula3Abdominalabscess4Long-termapplicationofhighcaloriaparenteralnutrition(fatemulsion)livertumefactionliverdysfunctionSGPT36SGOT144TB167.9DB102.85HR170RR55PaCO223.8WBC18700Positiveb

4、loodcultivation6Jan16thsepticshockJan17thRenalfunctionBUN20.5Cr337needinhalationofoxygenwithmaskcontinuoushemofiltrationJan19thtracheotomyventilatorapplication7Case2male59yExtensiveanteriorwallMyocardialinfarction20daysafteronset(2002/3/6)continuousventr

5、iculartachycardia→ventricularfibrillationelectricdefibrillation5timesantiarrhythmicdrugscountershockdrugsventilatorapplication8HR120RR28PaCO226.8WBC126009Repeatedlyventriculartachycardiaandfibrillation，totally21timeselectricdefibrillationContinuoushyperp

6、yrexia、highWBC、HR≥90、RR≥22Cultivationnegative,antibioticsnoeffectivenessOrgandysfunctioncameincrowdsshockRespiratorydysfunctionDeteriorationofliverfunctionCastinurineroutinetest→BUN、Cr↑→oliguria、anuriaCoagulationabnormalitydeath10AcuteonsetManifestatinof

7、excessiveinflammationDeteriotationofpts’conditionsdespiteactivetherapyMultipleorgandysfunctionDifferentpts,SameprogressCase1:infectiousCase2:noninfectious11clinicalbehaviorAccumulativeSubstanceirreversibleMultipleorganlowfunctioncausedbyinteractionbetwee

8、norgansChronicdiseaseMultipleorganlowfunction12MODSfollowedbyprimaryemergencydiseasein24hoursClinicalmanifestationburstoutSimultaneousdiequicklyprimaryMODSIschemiaischemiaandreperfusionphysicalandchemicalinjuryfactor13Sequ