多脏器功能不全5年制

多脏器功能不全Multiple

Organ

Dysfunction普外ICU陈

宏Multiple

Organ

Dysfunction

Syndrome(MODS)Multiple

Organ

Dysfunction

Syndrome(MODS)Concepts

in

Oxygen

Transport

and

Utilizationcardiac

outputoxygen

content氧供与氧耗Oxygen

delivery

and

utilizationO2

isrequiredfor

energy

.O2

demands

inexcess

of

supply

produce

an

O2debtthat

deleteriousApproaches

to

Increasing

Perfusionin

Appropriate

OrderEmanuel

Rivers,et

al

NEJMVolume

345:1368-1377Pathophysiology

of

MODSMethods

to

Decrease

Gut

Leak

ofEndotoxintonometryenteral

nutritionglutamine尽早肠内营养pHi值意义胃黏膜氧张力计（Tonometry）根据—哈塞耳 公式：pHi=6.1+lgHCO

-/0.03PsCO3

2pHi>7.32-7.35持续pHi<7.32超过24小时预后不良pHi局限性：-

-1、动脉HCO3

可能与黏

CO3

不同2、十二指肠液逆流PsCO2>PtCO2急性肾脏功能不全The

RIFLE

classification

scheme

for

acute

kidney

injury(AKI)severityeThe

Acute

Dialysis

Quality

Initiative

Group

Crit

2C0a0re22004;

8:R204–R2122005

AKIN

(Acute

Kidney

Injury

Network)Consensus

Meeting

modification

of

the

RIFLEAKISTAGESERUM

CREATININE

CRITERIAURINE

OUTPUTCRITERIA1Absolute

increase

≥0.3

mg/dL

or

Value

is

1.5-2×<0.5

mL/kg/hr

for

>6

hrbaseline

value

(

26.4mol/L)2Value

is

2-3×

baseline

value<0.5

mL/kg/hr

for

>12

hr3Value

≥3×

baseline

value

or

Value

≥4.0

mg/dL

with<0.3

mL/kg/hr

×

24

hr

orabsolute

increase

≥0.5

mg/dL

or

Patient

is

receivingAnuria

×

12

hrrenal

replacement

therapyCrit

Care

2007;

11:R31/血液透析原理血液滤过原理CRRT?ICU患者RRT指征、贾建国：CRRT实践操作CRRT的作用预防MODS:

需要一个神奇的盾牌(Ronco

Presentation

on

CD-ROM

San

Diego

2002)CRRT高容量血液滤过治疗对ARDS氧合指数的影响HVHFearly

goal-directedtherapy(EG