53例腹部外科脓毒症患者并发多器官功能障碍综合征的救治分析  

Treatment of 53 patients with MODS induced by severe surgical abdominal infection

作　　者：岳茂兴[1] 李学彪[1] 李成林[1] 杨鹤鸣[1] 姜玉峰[1] 张诗琳 刘志国[1] 

机构地区：[1]解放军第三零六医院腹部外科中心,北京100101

出　　处：《中华急诊医学杂志》2004年第12期808-811,共4页Chinese Journal of Emergency Medicine

基　　金：解放军总装备部卫生局重点科研课题资金资助项目(95 2 10 86) ;北京市科技攻关重大项目 (2 0 0 2 0 2 3 0 6)

摘　　要：目的　探索降低腹部外科脓毒症患者并发MODS的死亡率的综合治疗措施。方法　 (1)整体治疗MODS时 ,在“炎性介质、细菌、内外毒素、微循环、免疫功能、营养代谢、基础疾病、脏器功能”等方面进行兼顾和并治 ,并相应实施 14条具体治疗措施 ;(2 )提出了短程联合应用山莨菪碱、地塞米松为主的综合救治方案 ;(3)提出并应用了“分阶段代谢营养支持”治疗 ,减少了严重并发症的发生率 ;(4)采用自制的“解毒固本汤”配合治疗 ,以改善免疫紊乱状态、调控炎性介质等。结果　按KnausW A教授MODS的诊断标准 ,本组共 5 3例 ,应用传统常规疗法的 31例患者 ,2 2例死亡 ,死亡率为 70 96 %。采用采用综合救治新策略的 2 2例患者 ,死亡 8例 ,病死率为 36 36 %。两组经t检验 ,P <0 0 1。结论　腹腔严重感染致MODS治疗困难 ,病死率高 ,采用综合救治新对策疗法能降低MODS的病死率。Objective To investigate a combined treatment to reduce the mortality rate of MODS induced by severe surgical abdominal infection.Methods (1) While treating MODS, inflammatory mediators,bacteria, exotoxin and endotoxin,immune functions, dysfunction of microcirculation, nutrition and metabolism and function of organs should be considered as a whole. We also implemented 14 treatment protocols.As a result we got better curative effects.(2)Combining of anisodaminum and dexamethason short-term. (3)Provide nutritional support according to different stage of MODS,which can significantly reduce the complications. (4) Oral administration of“JIE-DU-GU-BEN-TANG”, developed by our division could regulate the imbalance of immunity and inflammatory mediator.Results According to the diagnostic standard of MODS brought forward by professor Knaus WA., the mortality rate of traditional treatment was 70.96% and the mortality of our new combined treatment was 36.36%, P<001(t-test).Conclusion It is difficult to treat MODS induced by severe abdominal infection,and our new combined treatment could significantly reduce the mortality.

关 键 词：MODS 患者 综合救治 治疗 病死率 脓毒症 腹部外科 并发 营养代谢 代谢营养 

分 类 号：R631[医药卫生—外科学]