创伤并发多器官功能障碍综合征过程中氧代谢监测的价值  

Value of monitoring oxygen metabolism in multiple organ dysfunction syndrome after severe trauma

作　　者：田利华[1] 高伟[1] 胡耑[1] 赵鸿[1] 易成腊[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,湖北武汉430030

出　　处：《中国危重病急救医学》2007年第1期21-24,共4页Chinese Critical Care Medicine

基　　金：湖北省科技攻关基金资助项目（2005AA301C31）

摘　　要：目的研究创伤后氧代谢变化及其对组织细胞代谢状况的评价，探讨创伤并发多器官功能障碍综合征（MODS）发生发展中氧代谢监测的价值。方法选择武汉同济医院救治的146例各类创伤患者。采集相关氧代谢检测数据和计算参数，比较危伤组与重伤组，MODS组与非MODS（NMODS）组。存活组与死亡组各指标的变化水平，以轻伤组相应指标测定结果作为对照。并与修正创伤评分（RTS）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分以及创伤与损伤严重度评分（TRISSRTs）法对Ps伤情或预后进行量化评价。结果氧代谢水平在创伤后即发生异常，与创伤严重度评分（ISS）、RTS、损伤器官部位与数量、低血容量性休克、全身炎症反应综合征（SIRS）以及是否并发呼吸系统合并症等有关；并发MODS患者氧代谢水平变化更为明显，与轻伤对照组和NMODS组比较相关氧代谢比值改变差异均有显著性；死亡组乏氧代谢指标常呈持续恶化趋势，其代谢水平改变越显著，预示器官功能损害程度越严重，往往于死亡前达到峰值。结论氧代谢水平变化与创伤并发MODS的发生发展密切相关，动态监测组织细胞氧代谢状况对MODS发病过程具有一定的预警意义。Objective To study changes in oxygen metabolism and evaluate metabolic status in tissue and cell after severe trauma, and to investigate value of monitoring oxygen metabolism in the course of development of multiple organ dysfunction syndrome （MODS） in trauma between patients. Methods The data of 146 patients with severe trauma in Tongji Hospital were collected. The variables pertaining to oxygen metabolism were analyzed, and the data were compared between patients with risky trauma and those with severe trauma, between patients complicated with MODS and non- MODS （NMODS）, and between survivors and nonsurvivors. With patients with minor trauma as control, the data were analyzed according to injury severity score （ISS）, revised trauma score （RTS）, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ）, trauma and injury severity score （TRISSRTs） methods for trauma and outcome study of probability of survival （Ps）. Results Oxygen metabolism abnormality was found after trauma, and it was correlated with ISS, RTS, injured organ or region and number of injured organs, shock, systemic inflammatory response syndrome （SIRS） and respiratory complications. It was more intense in the patients with MODS. There was marked difference in the ratio of change in oxygen metabolism between MODS and NMODS groups. Oxygen deficiency metabolic variables tended to deteriorate in the nonsurvival group. More marked changes in metabolic variables indicated severer organ dysfunction, reaching their peak values before death. Conculslon Changes in level of oxygen metabolism might be closely correlated with development of MODS in trauma patients. Dynamic monitorings of metabolic status of tissue and cell are valuable in predicting the development of MODS after severe trauma.

关 键 词：创伤 多器官功能障碍综合征 氧代谢 创伤评分 

分 类 号：R686[医药卫生—骨科学]