MODS

MODS

MODS MODS MODS(24h) MODS60%100%

1 .,,, 2 .(>24h),24h 3 ., 4 . 5 .

1,++ ,, 1 2 3 4() 5 6,

MODS systemic inflammatory response syndrome, SIRS 1 disseminated activation of inflammatory cells - C3a C5a - TNF IFN IL-1 IL-6 IL-8 PAF LTB4 TXA2 PF3-4 ADP P L adhesion molecule, AM

2 (proinflammatory mediator spillover) - priming TNF DIC .

compensatory anti-inflammatory response syndrome,CARS IL-4 IL-10 IL-13 PGE2 PGI2 NO sTNFR IL-1ra -1 SIRS < compensatory anti-inflammatory response syndrome CARS CARS 1996 Bone SIRS CARS SIRS CARS SIRS>CARS SIRS

- 02-Ca2+

MODS 1 - SIRS 2 DIC 3

1 1 hypermetabolism TNF IL-1 MODS 2

2 1 MODS 2 SIRS MODS

Fry Knaus MODS Mashall

FryMOF 5 >34.2mol/L (20mg/dl)GOTLDH1 24600ml >166.7mol/L(20mg/dl) MOF CVP20cmH2O1.96kPa >51.3mol/L (30mg/dl) GOTGPT>100U BUN18mmol/L250mol/L(3mg/dl)

KnausMOF 1HR54/min 2MAP6.53kPa49mmHg 3/ 4pH7.24PaCO26.54kPa49.49mmHg 1R5/min49/min 2PaCO26.67kPa50mmHg 3A-aDO246.7kPa350mmHg 44 1479ml/24h195ml/8h 2BUN35.7mmol/L100mg/dl 3Cr309.4mol/L 3.5mg/dl 1WBC30109/L 2PLT10109/L (320% Glasgow624h

() 2d( 3d5d7d) () >mol/L)2mg(177 2600mld>600mld >50mg(18mmolL) () >2mg (34mmolL) ALTASTLDH2 () 1 2 3 ( )

() 1. 2.

MarshallMODS PaO2/ FiO2mmHg 300 226~300 151~225 76~150 75 Crmol/L 100 101~200 201~350 351~500 >500 TBILmol/L 20 21~60 61~120 121~240 >240 PARbpm 10.0 10.1~15.0 15.1~20.0 20.1~30.0 >30.0 PLT109/L >120 81~120 51~80 21~50 20

Glasgow 15 13~14 10~12 7~9 6 1PAR/ 2PaO2/ FiO2PeepPeep 3 4GCS

MODSMarshall,9. 1.MODS 2.MODS 3. 4.

MODS .. 14-21 ...4 MODS PLTWBC

() ()CVPSwan-GanzPAWP(PCWP)PACO(CI) () 1(min) 2 3 TVIEPEEPFi02 () 1.pH 2. 3. 4.()

() ()(24h) () (LT) - AKPAFPLDH GT () 1 2 DICFIB 3PD- 3 () ()() ) () 1. 2. 3. () (K+Na+C1-Ca2+Mg2+P2+) (CuFeZnMg2+Ca2+Se) T3T4TSH VTV/QVO2-DO2 CrBUN ASTALT pHiD- PLTAPTTKPTT HRBP

MODSMODSMODS/MOF200210ESICM(ISF)MODS525%2004MODSC(APC)

1. MODS,40%

2. ALIARDSPaO2PEEP15cmH2060PaO2PaCO2PaO2ALIARDSNOLiquid ventilationECM0IVOX

3. CAVHD

(CRRT)(MODS) SIRMODS/--1-6MODSMOSF

MODSMODSCRRT--1-6MODSTNFLPS

4.MODS(BAL)(ALF)(MARS)MODSNO-6(IL-6)IL-8-(TNF-)-(INF-)Wang(LLC-PKI)ARF()MODS/MOF35.8%IL-10

5. MODSH2MODSMODSMODS310g231030gC

6.DIC MODSDIC

7. SIRSMODS

105kJ/kg5g/kg1.0g/kg1.52.0g/kgMODSMODSDalyw-3SIRS

8. MODSB BieskoMODSTNFILPAFSOD)MODSSDDMODS

9.MODSDong 2 390 MODS 85.2%76%MODS /Chai

10.MODS 80MODS33MODSLPSTNFIL-1PAF

MODSMODS(SIRS)ARDSMODSSIRSA2(PLA2)(PAF)MODSMODSMODS

TNFPGEC,E),

1. 2.SIRS 3.H2 4. 5. 6.

,(sirs)mods,,,,,,sirs,,modsmods,

1 2050irving,flemingnightingale,/deitch,,5 d;okada(sbs)3,sbs,,,,,

goris0,1,2/24 h,/,/2,,1,21995mods12(1)3,01,2,3,4

2 2.1 4IGM,-,,,/(),

:,,,,,,(gln),gln,,,,,,(paf)(tnf),,,,mods(lps),, ao3(dic)TNF(il)(ifn),,

,mods ,,,,,,mods mods,mods,,,

2.2 :101478%,,,1 kg,10121013,,,,,,,/,,,

,,,,

2.3 ,,,,,(), 2.4 3(galt)til-3il-5il-6ifn- IGAa(siga),siga,sigasiga,,leeuwen,70%,,,lps

3 3.1 3.2 (dao)dao,,95%,,,,,dao,dao,dao 3.3 d-:d-,d-,d-,,d-d-,

3.4 :,,,,,, 3.5 :24 h 3.6 ph(phi),co2,phiphi,phiphi,

4 4.1 :,,,,(tpn)mods,mods, 4.2 ,,,c

4.3 ,,,,phi,,,,,iga,,,,,,tnf

4.4 (sdd)sdd,,(),,,,,sdd:e:-,,:sdd(3 d),,

4.5 ,,,,,,,,,31,,,,-,,,,(),,,,,,,,,,,,,,,

4.6 4.6.1 h2,mods,,,,,,,mods 4.6.2 ,,,:,,,,,,: 4.6.3 -,,,,,,,,,5-,,

4.6.4 glngln,,gln,gln,gln,glngoetersglngln,9 d6gln,, 4.6.5 cd14cd14,tnf,

1 MODSMODSSwan-Ganz

2 MODS(DIC) MODSDICDICMODSDICMODS 3 045%5%231

4 K+Na+Ca2+Mg2+0.5 mmol/L

5 GHMODSGH 6 ENPNMODSENPNPN?1213 dENENMODS

7 MODS(ARDS)ARDSMODSMODS231 8 MODSICU

9 MODS10 10 H2H+-K+-ATPpH2pH4pH6MODSpH35 d 11 MODS2080

12 MODSARDS5 mg40 mg14 h 1ARDS50%MODS 13 BPCRRTMODSMODS

14 33 2000 15 ()ARDSO2CO2O2O2CO2O2CO2(PaO2)(PaCO2)CO2

16 ARDS(57 ml/kg)(PEEP)ARDSMODSICUMODS