(multiple organ dysfunction syndrome)
DESCRIPTION
多器官功能障碍综合征. (Multiple organ dysfunction syndrome). 30 、 40 年代 : 失血 休克. 90 年代 : MOF MODS. MODS 概念产生的历史背景 ( Historial origin of MODS concept ). 50 年代 : 急性肾功能衰竭. 60 年代 : ARDS. 70 年代 : 多发性、进行性、序贯性系统器官衰竭. 2. MODS 的定义 (concept of MODS) :. - PowerPoint PPT PresentationTRANSCRIPT
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(Multiple organ dysfunction syndrome)
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MODS (Historial origin of MODS concept) 50: 60: ARDS 70:2
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MODS(concept of MODS) : (multipleorgan dysfunction syndrome, MODS):
3
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(Causes and process of MODS)
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(Causes) 1. (infectious causes)2. (noninfectious causes)MODS 5
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6
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(Classification) 7
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(double hit)8
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(Mechanisms of multiple organ dysfunction syndrome)
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(The wild systemic inflammation response)ECC5a10C5a
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(systemic inflammatory response syndrome, SIRS): SIRSMSOFMOF11
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SIRS--12
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13SIRS:TNF-a - IL-1-6-8 NO
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14IL-6
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LPSTLR4MYD88MAPKKKMAPKIk-BNF-IL6AP-1CREBNFkB15
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SIRSSIRS >38C90/ >20/PaCO2 12109/L,10%16
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(compensatory anti-inflammatory response syndrome, CARS): SIRSCARSMARS17
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E2PGE2TH2IL-4-10TNF-aIL-1
GC
18
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SIRS CARS19
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(Ischemia and ischemia-reperfusion injury) Ischemia-reperfusion injury20
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(oxygen free radical ) (calcium overload)(leukocyte)-21
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(Damage of intestinal barrier and bacterial translocation) 22
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(bacterial translocation)23
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MODS(intestinal infection)24
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(Disorder of cell metabolism) 25
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hypermetabolism 1 2
3 26
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DO2VO227
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x ATP ( )28
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Apoptosis and Necrosis30
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Apoptosis signaling by CD95 (Left) TNFR1(Middle) and DR3(Right)
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MODSMODS34
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(Functional changes of multiple organs and systems)
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83%-100% (Functional changes of the lung)36
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MODS40%-55%3 (Functional changes of the kidney)37
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(Functional changes of the liver) 10%95%38
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(Functional changes of the gastrointestinal tract) 39
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(Functional changes of the heart) (Changes of the immune system) (Changes of the clotting system)40
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41
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MOF SIRSCARSMARSMOFMOF
MOF MOF MOF 42
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(criteria of judgement) : ARDSPaO2 177 mol/L>18mmol/L : LDHAKP : 43
- : < 1.5L/(min.m2):
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(Pathophysiological basis of prevention and treatment)
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(Prevention and treatment of primary disease)46
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(glucocorticoids) : (plasma Exchange)(Block the deleterious effects of inflammatory factors)47
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: (Others)48