多器官功能障碍综合征患者胰腺损害的探讨  

Discussion on multiple organ dysfunction syndrome involved with pancreas injury

作　　者：石松菁[1] 林兴盛[1] 杨火保[1] 

机构地区：[1]福建省立医院重症内科,福州350001

出　　处：《中华急诊医学杂志》2013年第8期846-849,共4页Chinese Journal of Emergency Medicine

基　　金：基金项目：福建省立医院重症医学科国家重点科室经费资助

摘　　要：目的探讨多器官功能障碍综合征患者出现胰腺损害时的病情特点。方法前瞻性研究2011年1月至2012年12月间入住福建省立医院内科ICU的MODS患者69例根据入院时是否合并胰腺损害将其分为胰腺损害组（A组）和单纯MODS组（B组），比较两组的急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、6h乳酸清除率、休克的发生率、24h及48h补液量、膀胱内压、28d累计病死率。结果A组患者APACHEⅡ评分明显高于B组（P〈0．01）；其6h乳酸清除率降低，休克的发生率明显增加，24h、48h所需补液量也大于B组（P〈0．05）；A组膀胱内压、肠鸣音减弱的发生率、病死率和B组比较均有升高，但差异均无统计学意义（P〉0．05）。结论MODS合并胰腺损害时，其病情往往较重，休克的发生率高，液体反应性较单纯MODS患者差。Objective To explore the clinical characteristics of multiple organs dysfunction syndrome （MODS） complicated with injury of pancreas. Methods A prospective study was carried out. From January 2011 to December 2012, a total of 69 patients with MODS in Department of Medical Intensie Care Unit, Fujian Provincial Hospital, Fujian Medical University were divided into 2 groups at admission. Patients of group A were suffered from MODS complicated with pancreas injury while patients of group B had MODS without complicatios. They were compared and evaluated by acute physiology and chronic health evaluation Ⅱ （APACHE [Ⅱ） score, 6-hour clearance rate of lactic acid, incidence of shock, fluid resuscitation in the first 24 and 48 hours, bladder pressure and 28-day accumulative mortality. Results APACHE Ⅱ score in group A was significantly higher than that in group B （ P 〈 0.01 ）. Compared with group B, the 6-hour clearance rate of lactic acid was lower, the incidence of shock increased obviously, and larger volume of fluid resuscitation was needed in the first 24 and 48 hours in the group A （ P 〈 0. 05 ）. Bladder pressure, incidence of feeble bowel sounds and the mortality in the group A were higher than those in group B, but the difference had no statistical significance （P〉0. 05 ）. Conclusions MODS complicated with pancreas injury is more severe than MODS without complications thereby resulting in higher incidence of shock and the poorer response to fluid resuscitation.

关 键 词：多器官功能障碍综合征 胰腺损害 淀粉酶 脂肪酶 乳酸清除率 膀胱内压 急 性生理功能和慢性健康状况评分系统Ⅱ评分 休克 

分 类 号：R459.7[医药卫生—急诊医学]