多系统器官衰竭(英文)课件

1、Multiple Organ Dysfunction Syndrome (MODS)多器官功能障碍综合征多器官功能障碍综合征Lecturer Dr. Xianmin Bu 卜献民Definition Multiple organ dysfunction syndrome MODS: Multiple organs or systems dysfunction occur simultaneously or progressively following severe infection, severe trauma and shock. The affected organs/systems

2、may be respiratory, cardiovascular, renal, hepatic, gastrointestinal, hematological, endocrine, and central nervous system. MODS is an important reason for the death of severe patient.The Evolution of MODSIn World War I, injured soldiers died in the battlefield of profound cardiac failure. This was

3、presumed to be caused by wound toxins, but clinical interventions were largely undefined.In World War II and to a greater extent in the Korean War, the loss of blood volume was recognized to be the primary cause of traumatic shock. battlefield casualties were resuscitated with blood and plasma until

4、 blood pressure returned to normal. As a result, more soldiers survived their initial insult; however, the severely injured often succumbed to oliguric renal failure. The Evolution of MODS1960s - ARDS was described in Vietnam “Shock Lung”.1973 - Tilney described multiple organ failure (MOF) or Multi

5、 System Organ Failure (MSOF). They concluded that MOF syndrome was the result of a combination of preexisting disease and hemorrhagic shock.1980s - began to realize concept of sepsis. MOF was considered as a fatal expression of uncontrolled infection.1990s systemic hyperinflammation became the focus

6、, now referred to as the systemic inflammation response syndrome (SIRS). The Evolution of MODSMODS replaces “Multi System Organ Failure” or MSOFMODS is a range of dysfunctional organs, not just failureAltered organ function in an acutely ill patient such that homeostasis cannot be maintained without

7、 interventionMOF and MODSMultiple organ failure (MOF):Progressive distant organ failure (initially uninvolved) following severe infectious or noninfectious insults (severe burn, multiple trauma, shock, acute pancreatitis)MOF is the finality of MODSmechanism basis diseases:1.Severe tissue injury or b

8、lood and fluid loss due to trauma, burn and major operation2.Severe infection3.Shock4.resuscitation of cardiac and respiratory arrest5.Acute haemorrhagic necrotic pancreatitis, colic intestine obstruction, rewarming of cold injury6.Misapplication of infusion, drug, or respirator.7.Primary disease: c

9、oronary heart disease, liver cirrhosis, chronic nephrosismechanismThe mechanisms of MODS are enormously compiex and poorly understood.Systemic inflammatory response syndrome (SIRS) is the main reason of MODS.Definition: pathologic inflammatory response to injury or infectionDiagnostic criteria: any

10、two or more of the following manifestations: 1.temp 38 or 90/min 3.respiratory rate 20/min or hyperventilation (PaCO2 12,000 cells/mm3,or 10% mechanismTo every action there is always opposed an equal reaction: or, the mutual action of two bodies upon each other are always equal, and directed to cont

11、rary parts.-Sir Isaac Newton, 1687Compensatory anti-inflammatory response syndrome (CARS)Imbalance of inflammatary response and anti-inflammatory response SIRS CARS, MODS occurs.mechanismEnterogenous infection ischemic injury Intestine mucosal barrier dysfunction Bacterial Translocation Enterogenous

12、/entr infection release of inflammatory mediators MODsClinical feature and diagnosisTwo type: Primary: rapid, 24 hours after acute primary disease, two or more organs dysfunction. The occurrence of MODS is due to a direct injury or insult to an organ or system. As contusion of lung from trauma, coag

13、ulapathy induced by multiple blood transfusion, acute renal shut down from drugs. Secondary: tardy, after an initial organ dysfunction and a steady period, two or more organs dysfunction occurs secondarily. it is a consequence of the host response, which result in an inflammatory response in organ d

14、istant from the site of the initial insult.Cardiovascular Acute heart failuer:Tachycardia, arrhythmiaAbnormal ECGShock :BP, coldness of extremities, oliguria microcirculation abnormalRespiratory acute respiratory distress syndrome (ARDS):tachypnea, wheezing, cyanose, dependence upon oxygenation supp

15、ort and mechanical ventilationHyperventilation results in respiratory alkalosisSevere hypoxemia, abnormal respiratory function.mechanical ventilationRenal Acute renal failure(ARF):Sudden decline of urine output (less than 400ml/24hour) despite adequate fluidsSpecific gravity of urine Nain urine and

16、Crin bloodGastrointestinal Stress ulcer and intestinal paralysis:Haematemesis呕血 hematochezia 便血 abdominal distention weak bowel soundsgastroscopeHepatic Acute hepatic failure :Jaundice Mind abnormal hepatic encephalopathyAbnormal biochemical liver function tests : bilirubin lift Neurological Central

17、 Nervous System failure: Conscious disturbance reactive depression of pain and sound stimulationDisseminated intravascular coagulation (DIC) Ecchymosis 淤斑 Haematemesis 呕血 Haemoptysis 咯血 platelet count, fibrinogen, thrombin time (PT), partial thrombin time (PTT) Early diagnosis1.Acquaintance with the

18、 high risk factors of MODS.severe infection (sepsis), trauma, burn, acute severe pancreatitis, etcTachypnea, Tachycardia, low BP, mind abnormal, oliguria, etc.The diagnosis of infection is very important.Early diagnosis2. SIRS + organ dysfunction = MODSOrgan dysfunction caused by SIRS induced damage

19、 such that homeostasis cannot be maintained without supportive measures SIRS must be identified as soon as possible in order to institute immediate treatment to try and prevent progression to MODS Early diagnosis3. Multiple organ dysfunction occurs progres-sively, either the initial organ or a dista

20、nt organ.One organ dysfunction occurs, the others should be detected in time.DIC: ARDS, ARF, GI hemorrhage and cerebral hemorrhageIn clinic, ARDS hepatic failure, ARF and GI failure.Early diagnosis4. Pay more attention to organ dysfunction than organ failure. That SIRS evolves into MODS is a dynamic

21、 process.The dysfunction may be partial or complete, reversible or irreversible Early diagnosis5. Dysfunction of heart, lung, brain and kidney has a clear clinical manifestation, while until severe stage, dysfunction of liver, GI and haematological system has not a clear clinical manifestation. Some

22、 special accessory examinations are essential.Prophylaxis and treatmentSynthetic and Supportive TherapyHigh mortalityProphylaxis is more important.Prophylaxis and treatment1. Improve the quality of resuscitation, attach importance to circulation and respiratory. correct hypovolemia, restore tissue p

23、erfusion and oxygen transportation Prophylaxis and treatment2. Control infection is a important measure to prevent MODS.Drainage of infectious focus, clearance of necrotic tissuesLocalization of infection to alleviate toxemia.AntibioticsProphylaxis and treatment3. To manage single organ dysfunction

24、early and block the pathologic chain reaction.More organs failure high mortality4. Improve general conditions.5. Protect intestinal mucous barrier, prevent bacterial translocation.6. Immune regulation acute renal failure(ARF)Defination Acute renal failure is a condition in which the glomerular filtration rate is abruptly reduced, causing a sudden retention of endogenous metabolites that are normally cleared by the kidneys. Commonly, ARF is characterized by sudden reduce of urinary output.oliguria urine volume400ml/dayauria urine volum