高渗血症与多器官功能障碍综合征相关性研究  

Plasma Hyperosmolarity Associated with Multiple Organ Dysfunction Syndrome

作　　者：胡检生[1] 徐南平[2] 

机构地区：[1]井冈山大学医学院,江西吉安343000 [2]江西省儿童医院,江西南昌330006

出　　处：《黑龙江医学》2011年第12期886-888,891,共4页Heilongjiang Medical Journal

基　　金：江西省吉安市市级课题

摘　　要：目的探讨高渗血症对多器官功能障碍综合征(MODS)预后的影响,为临床防治MODS提供有价值的干预方法。方法选择2008-01～2011-07间,我院PICU收治的165例MODS患儿为研究对象,动态监测血糖、血电解质、血气分析、血浆渗透压值变化,按照血浆渗透压计算值将MODS患儿的分为高渗组与非高渗组,比较分析两组临床资料对MODS预后的影响。结果本组资料165例MODS患儿中,合并高渗血症的患儿50例,发病率30.3%;高渗组死亡35例,病死率70.0%;非高渗组115例,死亡50例,病死率43.5%,两组比较差异有统计学意义(P<0.05);血浆渗透压在290～330 mmol/L、331～350 mmol/L病死率分别是53.6%、85.7%,两者比较有显著差异性(χ2=8.673,P=0.013),当血浆渗透压>350 mmol/L,死亡率为100%。结论高渗血症是MODS常见的并发症,发病率高,常使原发病加重,且随着血浆渗透压水平升高,病死率亦随之增加,MODS患儿并发高渗血症后的病死率明显高于非高渗者。Objective To investigate the prognostic influence of plasma hyperosmolarity on multiple organ dysfunction syndrome（MODS）,and to provide valuable intervention methods for the clinical prevention and treatment of MODS.Methods 165 cases of children with MODS in PICU of our hospital,from January 2008 to July 2011,were observed.The dynamic monitoring of blood glucose,blood electrolytes,blood gas analysis and plasma osmotic pressure variation were recorded.In accordance with the plasma osmolality calculated value,the cases were divided into hypertonic group and non hypertonic group.To compare the prognosis between two groups.Results 50 patients were complicated with hypernatremia,incidence of 30.3%;hypertonic group 35 patients died,the mortality rate was 70%,non hypertonic group was 115 cases,50 cases died,the mortality rate was 43.5%,there was significant difference between two groups（P0.05）;when the osmotic pressure of plasma in 290~330 mmol/L,331~350 mmol/L fatality rates were 53.6%,85.7%,respectively.There was significant difference between two groups（χ2=8.673,P=0.013）,when the plasma osmotic pressure is greater than 350 mmol/L,mortality is 100%.Conclusion Plasma hyperosmolarity is a common complication of MODS.It has high incidence,often make Primary disease exacerbation,and with the blood osmotic pressure levels increased mortality rate also increases.MODS mortality after complicated by plasma hyperosmolarity significantly increased.

关 键 词：高渗血症 高钠血症 高血糖 多器官功能障碍综合征 

分 类 号：R725.6[医药卫生—儿科]