病理生理学课件-MODS.pptVIP

胃肠功能障碍 胃肠道功能障碍的发生机制 1. 应激反应引起胃肠道出血 2. 自由基作用，因胃肠富含黄嘌呤氧化酶 3. 长期静脉营养，胃肠道粘膜萎缩，屏障 功能降低 病理变化与临床表现 　溃疡与出血，腹痛、消化不良、呕 血和黑便。 心功能障碍 心脏功能障碍的发生机制 １. 冠脉血流量减少，心率加快，心肌耗 氧增加，缺氧加重 ２. 水、电解质和酸碱平衡紊乱 ３. 心肌抑制因子使心肌收缩性减弱 ４. 心肌内DIC对心肌的影响 ５. 细菌毒素引起心功能的抑制 病理变化与临床表现 　心肌坏死、凋亡，心指数下降(＜3.0L/min·m3) 防治原则 防治感染和创伤等以去除MODS的病因； 及时补足血容量，防治休克和缺血－再灌注损伤； 阻断炎症介质的有害作用； 尽可能由胃肠道进食； 提高氧供，增加组织对氧的摄取； 代谢支持－－正氮平衡，提高蛋白质及氨基酸的摄入。 Study Goal 掌握： 概念：MODS, MOF,SIRS, CARS。 熟悉： MODS的病因、分型与发病机制。 了解： MODS时系统器官的功能变化。 * * * * 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 are still a lot of blackholes for us. Till now, MODS is still the most important death cause of the patient in ICU. * * Finally, let us have a short summary about what we have studi