taking oxygen
blood gas analysis
Kidney ARF
Liver AHF
oliguria anuria
jaundice
urinalysis creatinine
bilirubin CT MRI
Brabance
Coagulation DIC bleeding petechia
二、临床表现（Clinical Findings）
1、Characteristic: Diversification Domino effect 2、Typing: Quickly typing: emergency case after 24 hour
appear two or more organ-system dysfunction earlier one organ dysfunction, subsequently to take place more organ-system dysfunction
need for mechanic ventilation;PaO2/FiO2 ratio < 200mmHg for 24h Need for inotropic drugs to maintain adequate tissue perfusion; CI<2.5L/min/m2 Creatinine >3mg/dL on 2 consecutived or need for renal replacement therapy Bilirubin>3mg/dL on 2 consectived or
acute disease process proceed two and more organ dysfunction and failure at the same time or sequence.
一、概述(General Considerations）
MODS是目前外科最具挑战性、 最重要的并发症(complication)，是 ICU(intensive care unit)常见的死亡 原因。
platelet count fibrigen
Diagnostic Criteria for Significant Organ Dysfunction
Organ System
Pulmonary Cardiovascular Kidney Liver CNS Coagulation
Criteria
Slowly typing :
三、诊 断（ Diagnosis）
the following should be defined for diagnosis MODS high risk factor for MODS 。 systemic inflammatory response syndrome SIRS： fever，palpitation，speed pulse，tachypnea， leukocytosis。 Certain organ dysfunction influence to other organ earlier diagnosis and experiment treatment Check on：blood, urine, liver function, ECG,CVP Diagnostic criteria for MODS primary disease +SIRS+organ dysfunction（≥2）
名称
作者
年份
1973
Sequential system failure Tilney Multiple progressive or sequential systems failure Baue Multiple organ failure Eiseman Multiple systems organ failure Fry
Preliminary assessment of MODS
Organ disease Heart AHF clinical situation test or detection electrocardiogram arrhythmia tachycardia
Lung
ARDS
short breath cyanosis
PT>15 control
Glasgow Coma Scale score <10 without sedation Platelet count<50,000/mm3; Fibrinogen <
100mg/dL or need for factor replacement
CI:cardiac index;
cytokine vasoconstriction
inflammatory mediator
pathological product
ischemia-reperfusion injury
systemic inflammatory response syndrome
MODS
六种学说
炎症反应 微循环障碍 自由基 肠道动力 二次打击 代偿性抗炎反应
CNS:central nervous system;
1975 1977 1980 1985
1991
Acute organ-system failure
Knaus
ACCP
Multiple organ dysfunction syndrome
第一节、概
论(outline)
定义(difinition)： MODS是指急性疾病过程中同 时或序贯继发两个或更多的 重要器官的功能障碍。
1、病因(etiological factor) :
创伤(wound)
手术(operation)
感染(infection)(main factor)
休克(shock)
出血性坏死性胰腺炎
(necrotizing pancreatitis)
2、发病机制（pathogenesis）
etiological factor —body— defense reaction —stable