(Multiple organ dysfunction syndrome)

MODS (Historial origin of MODS concept) 50: 60: ARDS 70:2

MODS(concept of MODS) : (multipleorgan dysfunction syndrome, MODS):

3

(Causes and process of MODS)

(Causes) 1. (infectious causes)2. (noninfectious causes)MODS 5

(Classification) 7

(double hit)8

(Mechanisms of multiple organ dysfunction syndrome)

(The wild systemic inflammation response)ECC5a10C5a

(systemic inflammatory response syndrome, SIRS): SIRSMSOFMOF11

SIRS--12

13SIRS:TNF-a - IL-1-6-8 NO

14IL-6

LPSTLR4MYD88MAPKKKMAPKIk-BNF-IL6AP-1CREBNFkB15

SIRSSIRS >38C90/ >20/PaCO2 12109/L,10%16

(compensatory anti-inflammatory response syndrome, CARS): SIRSCARSMARS17

E2PGE2TH2IL-4-10TNF-aIL-1

GC

18

SIRS CARS19

(Ischemia and ischemia-reperfusion injury) Ischemia-reperfusion injury20

(oxygen free radical ) (calcium overload)(leukocyte)-21

(Damage of intestinal barrier and bacterial translocation) 22

(bacterial translocation)23

MODS(intestinal infection)24

(Disorder of cell metabolism) 25

hypermetabolism 1 2

3 26

DO2VO227

x ATP ( )28

Apoptosis and Necrosis30

Apoptosis signaling by CD95 (Left) TNFR1(Middle) and DR3(Right)

MODSMODS34

(Functional changes of multiple organs and systems)

83%-100% (Functional changes of the lung)36

MODS40%-55%3 (Functional changes of the kidney)37

(Functional changes of the liver) 10%95%38

(Functional changes of the gastrointestinal tract) 39

(Functional changes of the heart) (Changes of the immune system) (Changes of the clotting system)40

MOF SIRSCARSMARSMOFMOF

MOF MOF MOF 42

(criteria of judgement) : ARDSPaO2 177 mol/L>18mmol/L : LDHAKP : 43

: < 1.5L/(min.m2):

(Pathophysiological basis of prevention and treatment)

(Prevention and treatment of primary disease)46

(glucocorticoids) : (plasma Exchange)(Block the deleterious effects of inflammatory factors)47

: (Others)48

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