Decreased ability to fight infection
Introduction
Introduction Damage to the body's function leads to a decline in the body's function, and the body's ability to fight infection will decline. The syndrome of multiple organ dysfunction in the elderly is a manifestation of decreased infection. It can also be seen in situations where the immune system of the body is underdeveloped or damaged too much.
Cause
Cause
Multiple organ dysfunction syndrome in the elderly is an important cause of death in elderly critically ill patients. Because the occurrence of multiple organ dysfunction in the elderly is the simultaneous or sequential onset of two or more organs, the process is similar to the domino phenomenon, so identifying which is the first organ, just like finding the first one in the dominoes Like the dominoes, it is important to identify or block the occurrence of a chain phenomenon of organ dysfunction or failure, and the association between its organs.
The main basis is:
1. Aging lung has the pathophysiological basis for initiating organ dysfunction in the elderly. As you age, your lungs age and function decline. Therefore, the same external stimuli cause the lung disease of the elderly to be more serious than the young and middle-aged, difficult to treat, and the prognosis is poor.
2. Lung is the only important organ in human life that directly contacts the outside world. It is most exposed to external stimuli, and the inflammatory reaction is strong. The toxins produced are more harmful to important organs.
3. The immune function of the elderly is low, and the special defense function of the lungs is weakened. Long-term, large-scale clinical treatment found that lung infections accounted for 75.4% to 82.8% of the causes of multiple organ failure in the elderly. These characteristics determine that the lungs are the most vulnerable organs in the human body and most vulnerable to internal and external factors.
Examine
an examination
Related inspection
Dynamic electrocardiogram (Holter monitoring) blood routine
Due to physiopathological changes such as aging and chronic diseases, the clinical manifestations of MODSE are significantly different from those of young and middle-aged MODS, showing the following signs:
1, often occurs on the basis of organ function damage
Simple age-increasing factors can cause the function of various organs in the elderly to decrease by a third, and the chronic diseases further reduce the function of the affected organs. According to statistics, in China's MODSE, there are 2.4 important chronic diseases per capita, and 9 of them are more. Once an organ is stimulated by a predisposing factor, its function will deteriorate drastically, causing a chain reaction that leads to multiple organ failure.
2, infection and acute exacerbation of chronic diseases is a common cause
Infections, especially lung infections, are often the main cause (64%-74%). Acute exacerbations of chronic diseases are also the main cause. Central cerebrovascular emergencies are more common (9.3%), others have gastrointestinal bleeding, sepsis, surgery and trauma. , nephrotoxic drugs, etc.
3, the order of organ failure is related to the original chronic disease
The first organ without organ and the order are closely related to the degree of damage to the original organ function, with the lungs and heart first, followed by the brain, kidney, gastrointestinal and liver.
Diagnosis
Differential diagnosis
(1) Early inflammatory response in the systemic inflammatory response
Systemic inflammatory response (SIR) appears in the body as high metabolism (high oxygen consumption, oxygen consumption and oxygen supply for pathological dependence, hyperglycemia, enhanced protein catabolism, negative nitrogen balance and high lactate) high power cycle ( High cardiac output, low peripheral resistance) and excessive inflammatory response, ie, body temperature > 38 ° C or 90 min, breathing > 20 / min or PaCO 212 × 109 /.
(two) tissue oxygen supply and demand metabolic disorders
When the patient is under severe stress and the systemic inflammatory response is out of control, the sympathetic nerve excitability is increased, the body is in a high metabolic state, and the oxygen consumption is increased. However, these patients have different tissue hypoxia at this time, thereby causing oxygen supply and demand metabolic disorders.
(C) tissue cell energy, nutritional metabolism disorders
Under the condition of ischemia and hypoxia persistence, the body will further affect the ability and nutrition metabolism as the disease develops and deteriorates, and the structure and function of mitochondria are impaired. Insufficient ATP production, fat and protein metabolism can not enter the cyclic oxidation of tricarboxylic acid, the metabolism of nutrients in the body is disordered, protein decomposition is strengthened, total protein synthesis is decreased, a large number of branched-chain amino acids are oxidized, aromatic amino acids are increased, and branched-chain amino acids are decreased. The body is in a negative nitrogen balance.
