1、Multiple Organ Dysfunction Syndrome (MODS)多器官功能障礙綜合征Definition Multiple organ dysfunction syndrome （MODS）: Multiple organs or systems dysfunction occur simultaneously or progressively following severe infection, severe trauma and shock. The affected organ systems involved are: respiratory, cardiovas

2、cular, renal, hepatic, gastrointestinal, hematological, endocrine, and central nervous system. MODS is an important reason for the death of severe patient.The Evolution of MODSIn World War I, injured soldiers died in the battlefield of profound cardiac failure. This was presumed to be caused by woun

3、d toxins, but clinical interventions were largely undefined. In World War II and to a greater extent in the Korean War, the loss of blood volume was recognized to be the primary cause of traumatic shock. battlefield casualties were resuscitated with blood and plasma until blood pressure returned to

4、normal. As a result, more soldiers survived their initial insult; however, the severely injured often succumbed to oliguric renal failure. The Evolution of MODS1960s - ARDS （acute aspiratory distress syndrome) was described in Vietnam as “Shock Lung”.1973 - Tilney described multiple organ failure (M

5、OF) or Multi System Organ Failure (MSOF). They concluded that MOF syndrome was the result of a combination of preexisting disease and hemorrhagic shock.1980s - began to realize concept of sepsis. MOF was considered as a fatal expression of uncontrolled infection.1990s systemic hyperinflammation beca

6、me the focus, now referred to as the systemic inflammation response syndrome (SIRS). MOF and MODSMODS replaces Multiple Organ Failure(MOF)Multiple organ failure (MOF):Progressive distant organ failure (initially uninvolved) following severe infectious or noninfectious insults (severe burn, multiple

7、trauma, shock, acute pancreatitis)MODS is a range of dysfunctional organs, not just failureAltered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention.MOF is the finality of MODSmechanismThe mechanisms of MODS are enormously complex and poorly und

8、erstood.Systemic inflammatory response syndrome (SIRS) is the main reason of MODS.definition: pathologic inflammatory response to injury or infectiondiagnostic criteria: any two or more of the following manifestations: 1.temp 38 or 90/min 3.respiratory rate 20/min or hyperventilation (PaCO2 12,000 c

9、ells/mm3,or 10% mechanismenterogenous infection ischemic injury intestine mucosal barrier dysfunction bacterial translocation enterogenous infection release of inflammatory mediators MODSclinical feature and diagnosistwo types: primary: rapid, 24 hours after acute primary disease, two or more organs

10、 dysfunction. The occurrence of MODS is due to a direct injury or insult to an organ or system. As contusion of lung from trauma, coagulapathy induced by multiple blood transfusion, acute renal shut down from drugs. secondary: tardy, after an initial organ dysfunction and a steady period, another or

11、 more organ(s) dysfunction occur(s) secondarily. It is a consequence of the host response, which result in an inflammatory response in organ distant from the site of the initial insult.respiratory system acute respiratory distress syndrome (ARDS):tachypnea, wheezing, cyanose severe hypoxemia, abnorm

12、al respiratory functionhyperventilation results in respiratory alkalosisdependence upon oxygenation support and mechanical ventilationgastrointestine stress ulcer and intestinal paralysis:hematemesis嘔血 hematochezia 便血 abdominal distention weak bowel soundsgastroscopeliver acute hepatic failure :jaun

13、dice mind abnormal hepatic encephalopathyabnormal biochemical liver function tests : bilirubin, transaminase neurological system central nervous system failure: conscious disturbance reactive depression of pain and sound stimulationdisseminated intravascular coagulation (DIC) ecchymosis 淤斑 hematemes

14、is 嘔血 hemoptysis 咯血 platelet count, fibrinogen, thrombin time (PT), partial thrombin time (PTT) early diagnosis1.acquaintance with the high risk factors of MODS.early diagnosis2. SIRS + organs dysfunction = MODSorgans dysfunction caused by SIRS induced damage such that homeostasis cannot be maintain

15、ed without supportive measures SIRS must be identified as soon as possible in order to institute immediate treatment to prevent progression to MODS early diagnosis4. Pay more attention to organ dysfunction than organ failure. That SIRS evolves into MODS is a dynamic process.The dysfunction may be pa

16、rtial or complete, reversible or irreversible Early diagnosis5. Dysfunction of heart, lung, brain and kidney has a clear clinical manifestation, while until severe stage, dysfunction of liver, GI and haematological system has not a clear clinical manifestation. Some special accessory examinations ar

17、e essential.Prophylaxis and treatment1. Improve the quality of resuscitation, attach importance to circulation and respiratory. correct hypovolemia, restore tissue perfusion and oxygen transportation prophylaxis and treatment2. Control infection is a important measure to prevent MODS.Drainage of inf

18、ectious focus, clearance of necrotic tissuesLocalization of infection to alleviate toxemia.Antibioticsprophylaxis and treatment3. To manage single organ dysfunction early and block the pathologic chain reaction.The more dysfunctional organs, the higher mortality.4. Improve general conditions.Correct

19、 disorder of water and electrocytesCorrect disturbance of acid-base balanceCorrect hypoalbuminemiaCorrect malnutritionProphylaxis and treatment5. Protect intestinal mucous barrier, prevent bacterial translocation. use of glutamine, somatropin (growth hormone)6. immune regulation use of thymopeptides

20、 and human immunoglobulins acute renal failure(ARF)definition Acute renal failure is a condition in which the glomerular filtration rate is abruptly reduced, causing a sudden retention of endogenous metabolites that are normally cleared by the kidneys. Commonly, ARF is characterized by sudden reduce of urinary output.oliguria urine volume400ml/dayauria urine volume400mlLast for 14 daysHypokalemia and secondary infectionDiagnosisMonitor urine volume and examine urine Blood examination pro