老年急症患者并发多器官功能障碍的临床分析  

Multiple organ dysfunction syndrome in elderly emergency patients

作　　者：李小宇[1] 秦俭[1] 华琦[2] 

机构地区：[1]首都医科大学宣武医院急诊科,北京100053 [2]首都医科大学宣武医院心脏中心,北京100053

出　　处：《中华老年心脑血管病杂志》2013年第10期1030-1032,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：首都医学发展科研基金(2009-1054)

摘　　要：目的探讨老年急症患者并发老年多器官功能障碍发病原因、影响因素及临床预后。方法回顾性分析急诊科及入住ICU年龄≥60岁的676例患者的病历资料，分析所有患者器官功能障碍数目、类别及住院期间病死率；采用logistic回归分析影响病死率的相关因素。结果随患者器官功能障碍数目的增加，病死率升高，差异有统计学意义（P〈0．01）；各器官功能障碍的病死率依次为脑（33．3％）、肾脏（30．1％）、胃肠（23．2％）、心脏（17．7％）、肺脏（17．1％，P〈0．01）；低蛋白血症患者病死率33．7％。logistic回归分析显示，病死率与脏器功能障碍数目及低蛋白血症相关（OR=4．550，95％CI：3．274～6．324，P=0．000；OR=3．330，95％CI：1．860～5．961，P=0．000）。结论老年多器官功能障碍发生率及病死率高，预后差，应在治疗主要病因的同时注意保护各器官功能，尽早采用营养支持以纠正低蛋白血症，降低病死率。Objective To study the etiology, influencing factors and clinical prognosis of elderly pa- tients with multiple organ dysfunction syndrome. Methods Clinical data （including the number and types of dysfuncting organs and in hospital mortality） about 676 multiple organ dysfunction syndrome patients with their age ≥60 years were retrospectively analyzed. Relevant factors for the mortality of patients were analyzed by multivariate logistic regression analysis. Results The mortality increased with the number of dysfuncting organs （P 〈 0. 01）. The mortality was 33.3%,30.1%,23.2%, 17.7% and 17. 1% due to brain, kidney,gastrointestine, heart and lung dysfunction,respectively （P 〈 0. 01 ）. The mortality of hypoproteinaemia patients was 33. 7 %. Multivariate logistic regression analysis showed that the mortality was positively related with the number of dysfuncting organs and hypoproteinaemia （OR= 4. 550,95% CI： 3. 274-6. 324, P= 0.000;OR=3.330,95GCI：1. 860--5. 961,P=0. 000）. Conclusion The incidence and mortality of multiple organ dysfunction syndrome are rather high in elderly subjects with a poor prognosis. The function of different organs should be protected during the treatment of multiple organ dys- function syndrome. Hypoproteinemia should be reversed by nutritional support in order to reduce the mortality of multiple organ dysfunction syndrome patients.

关 键 词：急症 多器官功能衰竭 营养支持 低蛋白血症 医院死亡率 

分 类 号：R459.7[医药卫生—急诊医学]