病理生理学（王新风）SIRSMODS.pptVIP

(五) 心功能障碍 发生率10%～23% 2．临床表现 突发性低血压（ 60mmHg）; 心指数2.0 L/min.m2 ; 对正性肌力药物不起反应。 1．机制 （1）心肌高代谢率、高耗氧率、冠脉供血↓； （2）酸中毒、高钾血症损伤心肌； （3）内毒素、TNF、IL-1抑制心肌。 (六) 免疫系统功能障碍 MODS早期，免疫系统被激活： 感染 —→免疫复合物 —→沉积于多个器官微血管内皮细胞 —→直接毒性作用或趋化PMN —→器官功能障碍。 MODS晚期，免疫系统处于全面抑制状态： PMN和单核吞噬细胞吞噬功能↓，杀菌功能↓，B细胞产生抗体的能力↓，抗炎介质（IL-4、IL-10、IL-13）产生 —→抑制免疫功能—→感染容易扩散。 (七)凝血功能障碍 DIC临床表现：血小板计数进行性↓，凝血酶时间↑、凝血酶原时间↑，纤维蛋白原↓、纤维蛋白降解产物↑ （八）中枢神经系统功能障碍 （1）血压50 mmHg —→ 脑组织缺血缺氧 （2）高分解代谢 —→ 假性神经递质↑ —→CNS功能障碍（反应迟钝，意识和定向力障碍，昏迷） 多系统器官功能间紧密联系，相互影响，并可以形成因果联系。 五、防治原则 重在预防 （一）防治感染和创伤 清除感染灶、抗生素 （二）防治休克和缺血-再灌注损伤 补充血容量 抗氧化剂、细胞保护剂、自由基清除剂、钙拮抗剂 （三）阻断炎症瀑布反应 糖皮质激素、TNF-α和IL-1抗体 （四）一般支持治疗 缩短禁食时间；热量平衡；正氮平衡，增加支链氨基酸 期末考试题型 单选 1分×40 多选 1分×10 简答 5分×6 论述 10分×2 * Finally, let us have a short summary about what we have studied this time. We know MODS is a kind of emergent clinical syndrome. It involves the dysfunction of two or more organs. It develops in very short time. MODS can be caused by both infective and noninfective diseases. Whatever the reason is, the clinical manifestations of these two types are not different. So we pay much attention on the common mechanisms of MODS. Uncontrolled inflammatory response is the most important factor to trigger MODS. In some of the patient, this uncontrolled inflammatory response may be presented as overregulated pro-inflammatory response. So, we can observe the disseminated pro-inflammatory mediators in the circulation. Some of the mediators are harmful to the body tissues, such as TNF-a, Free radical. That is the reason why these distant organs can receive the signal and become failure. We call this phenomena as systemic inflammatory response syndrome. The other type is compensatory anti-inflammatory response syndrome. The patients have overexpressioned anti-inflammatory mediators so they cannot confront with the microoragnisms. And body tissues can be injuried by these foreigners. Although MODS has been studied for nearly 30 years, there a