腹部外科疾病并发MODS的临床救治研究  

Clinic research and combined treatment of MODS as a complication of severe abdominal surgical conditions

作　　者：岳茂兴[1] 李学彪[1] 李成林[1] 杨鹤鸣[1] 李新元[1] 赵尔增[1] 李建忠[1] 张诗琳 

机构地区：[1]中国人民解放军第306医院,北京100101

出　　处：《中华急诊医学杂志》2001年第1期17-20,共4页Chinese Journal of Emergency Medicine

基　　金：解放军总装备部卫生局重点科研课题资金资助项目! ( 95 2 10 86 ) ;全军科技成果二等奖! ( 2 0 0 0 0 6 0 9)

摘　　要：目的　MODS是腹部外科疾病患者死亡的最直接、最重要的原因之一。本研究探索有效合理的综合临床救治方法。方法　①短程大剂量山莨菪碱和地塞米松联用的综合治疗方法 ;②“分阶段代谢营养支持”治疗 ;③采用自制的“解毒固本冲剂”配合治疗 ;④针对“炎性介质、细菌、内外毒素”等 8个方面 ,提出了多环节兼顾和并治的 12条综合治疗具体措施 ;⑤生长激素和生长抑素治疗等 ;⑥手术治疗等。结果　按KnausW .A教授MODS的诊断标准 ,118例中共死亡 5 9例 ,病死率为 5 0 0 0 %。其中应用传统常规疗法的 87例 ,死亡 49例 ,病死率为 5 6 32 %。采用综合救治新策略的 31例中 ,共死亡 10例 ,病死率为 32 2 5 %。结论　MODS病因复杂 ,治疗困难 ,死亡率高 。Objective There is no good way for the treating of mutiple organ disfunction syndrom(MODS),at present so we want to find some combined treatment measures to cut down the death rate of the patients who suffer from abdominal surgical conditions complicated MODS.Methods ①Developing new treatment using a large dose of anisodaminum and dexamethasone together for a short time.②While treating MODS as a whole entity inflammatory mediators,bacteria,exotoxin and endotosxin,immunity,dysfunction of microcirculation,nutrition and metabolism,underlying diseases,and the organ function should be considered and managed together.We also carry out 12 concrete teatment measures.③Under the circumstances that on the one hand,the high metabolic rate needs to be supported,on the other hand,the organ can’t effectively use the nutrients and get rid of the metabolites; we provide nutritional support at different stages to minimize serious complications.④Using JIEDUGUBENTANG which was developed by ourselves,to improve immune dysfunction and regulate the inflammatory mediators.Results Fifty eight out of 116 patients died of MODS,mortality being 50 00%.Fouty nine of the 87 patients who were treated with conventional methods died,the mortality being 56 32%.Ten patients of the 31 patients who were treated with combined management measures died,the mortality being 32 25%.Conclusion MODS have complex pathogensis are difficult to be cured,and have high mortality.The mortalities of MODS can be decreased by using new combined treatment strategy.

关 键 词：腹部外科疾病 MODS 临床救治 并发症 

分 类 号：R656[医药卫生—外科学]