高原严重多发伤并发多脏器功能障碍综合征的危险因素及治疗策略  

Risk factors and therapeutic strategies for severe multi-trauma complicated with multiple organ dysfunction syndrome in early stage at high altitude

作　　者：马四清[1] 吴新民[1] 杨正平[1] 叶成杰[1] 赵琳[1] 石青军[1] 孙斌[1] 

机构地区：[1]青海省人民医院ICU ,西宁810007

出　　处：《国际麻醉学与复苏杂志》2009年第2期97-99,138,共4页International Journal of Anesthesiology and Resuscitation

基　　金：青海省科技厅资助项目（2005-N-122）

摘　　要：目的探讨高原严重多发伤并发多脏器功能障碍综合征（multiple organ dysfunction syndrome，MODS）的危险因素及治疗策略。方法回顾性分析2003年1月-2004年12月及2005年1月-2007年12月分别收住我院ICU的严重多发伤患者93例和98例，前者为A组，后者为B组。对两组患者的年龄、性别、急性生理与慢性健康评分（acute physiology and chronic healthy score，APACHE Ⅱ）、创伤严重度评分（iujury severityscore，ISS）、低氧血症、休克、脓毒症、凝血障碍、腹腔室隔综合征（abdomer compartment syndrome，ACS）、急性肾功能衰竭、高血糖等因素进行logistic分析，同时分析不同处理方式对严重创伤病死率的影响。结果A组和B组中分别有45（45／93）例和48例（48／98）严重创伤患者早期并发MODS，这些患者在休克、低氧血症、脓毒血症、ACS、凝血障碍、APACHE Ⅱ评分、ISS评分方面明显高于无MODS患者，差异有统计学意义（P〈0．01）。B组患者由于治疗策略转变，除治疗原发病外，还采用了早期液体足量复苏、纠正休克、纠正凝血紊乱、早期机械通气、目标血糖控制、充分镇静镇痛、抑制炎症反应、伴腹腔高压者早期行腹腔引流等措施，其病死率下降，与A组比较，差异有统计学意义（P〈0．01）。经相关危险因素分析，休克、低氧血症、脓毒血症是MODS发生的主要因素（P〈0．01）。结论高原地区严重创伤患者并发MODS的危险因素与休克、低氧血症、脓毒血症以及与临床处理的方式有关。积极纠正低氧血症、纠正休克、纠正凝血紊乱、目标血糖控制、充分镇静镇痛、抑制炎症反应是防止严重多发伤早期发生MODS的关键。Objective To explore the risk factors and therapeutic strategies for severe multi-trauma complicated with multiple organ dysfunction syndrome （MODS） at high altitudes. Methods Patients included 93 cases （group A） and 98 cases （group B） with severe trauma admitted from January 2003 to December 2004 and from January 2005 to December 2007, respectively. Age, gender, acute physiology and chronic healthy score （APACHE Ⅱ ）, injury severity score（ISS）, hypoxia, shock, sepsis, coagulation disorders, abdomen compartment syndrome （ACS）, blood glucose were analyzed for both groups using logistic analysis. Risk factors affecting the mortality of severe trauma in terms of treatment were analyzed. Results 45（45/93） cases in group A and 48（48/98）cases in group B were complicated with MODS in early stage. The conditions were more severe in patients with MODS than those in patients without MODS with regard to shock, hypoxia, ACS, coagulation disorders, APACHE II, ISS, and the difference were significant （P〈0.O1）. The mortality in group B was lower than that in group A because of improved therapeutic strategies including CBP, appropriate management of shock, corrective coagulation disorders, target glucose control, full sedation analgesia, inhibiting inflammation, ventilation and sufficient liquid resuscitation, the difference was significant（P〈0.01 ）. Logistic multiple regression analysis showed that all of risk factors were higher than in the patients of shock, hypoxia, septic shock. Conclusion Shock, hypoxia, sepsis and strategy of clinical treatment are corelated with multi-trauma complicated with MODS in early stage at high altitudes. Correcting hypoxia, shock and coagulation disorders, sufficient fluid resuscitation, target glucose control, full sedation analgesia, and inhibiting inflammation are the crux of preventing MODS in early multi-trauma patients.

关 键 词：多发伤 多器官功能障碍综合征 危险因素 病死率 高原 

分 类 号：R64[医药卫生—外科学] R459.7[医药卫生—临床医学]