急腹症与休克(附140例分析)  

Acute abdomen and shock:report of 140 cases.

作　　者：李孟军[1] 项建斌[1] 蔡端[1] 张延龄[1] 

机构地区：[1]上海医科大学附属华山医院普外科,200040

出　　处：《中国实用外科杂志》2000年第7期406-408,共3页Chinese Journal of Practical Surgery

摘　　要：目的　探讨外科急腹症合并感染性或出血性休克时的临床处理。方法　回顾性分析 140例急腹症与休克的临床资料。结果　 140例病人中感染性休克占 5 5 7% (78/ 140 ) ,原发病多为急性梗阻性化脓性胆管炎(AOSC) ;出血性休克占 44 3 % (6 2 / 140 ) ,多为外伤性肝脾破裂出血。抗休克治疗后 ,131例经手术治疗 ,治愈率为 6 8 7% (90 / 131) ,非手术治疗 9例 ,均死亡。治疗中发生急性呼吸窘迫综合征 (ARDS) 34例 ,总发生率为2 4 3 % (34/ 140 ) ,计感染性休克占 37 2 % (2 9/ 78) ,出血性休克占 8 1% (5 / 6 2 ) ,多发生在病程的 1～ 3天。发生急性肾功能衰竭 30例 ,发生率 2 1 4% (30 / 140 )。本组 140例病死率 35 7% (5 0 / 140 ) ,死亡主要原因为多脏器功能障碍综合征 (MODS)占 5 6 0 % (2 8/ 5 0 )。结论　外科急腹症合并休克时应首先紧急抗休克治疗 ,选择合适的手术时机及时手术是必要的 ,早期防治MODS可以降低其病死率。Objective To discuss the management of surgical acute abdomen with septic or hemorrhagic shock.Methods 140 cases of acute abdomen combined with shock were retrospectively reviewed.Results Among 140 cases,there were 78 cases(55 7%) of septic shock mostly caused by acute obstructive suppurative cholangitis(AOSC) and 62 cases(44 3%) of hemorrhagic shock mostly caused by severe injury of liver and/or spleen.131 cases with 90 cures accepted surgical treatment including drainage or debridement.Other 9 nonoperative patients all died.The mortality rate was 35 7%(50/140),28 patients died of multiple organ dysfunction syndrome(MODS).Acute respiratory distress syndrome (ARDS) and acute renal failure were main complications.Conclusion It is important to restore hemodynamic stability for the patients of acute abdomen with shock and take timely surgical treatment.Preventing the development of MODS may reduce the mortality.

关 键 词：急腹症 感染性休克 出血性休克 

分 类 号：R656.1[医药卫生—急诊医学] R631.4[医药卫生—外科学]