急腹症致大肠腑实证早期器官损害的特征及防治  

Characteristics of organ damages at early stage of dachang fushi syndrome induced by acute abdomen and their prevention and treatment

作　　者：周静丽[1] 傅强[1] 杜超[1] 崔乃强[2] 李志刚[1] 

机构地区：[1]天津医科大学第四中心临床学院,天津300140 [2]天津市南开医院,天津300100

出　　处：《中国中西医结合急救杂志》2016年第3期236-239,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家重点基础研究发展计划（973）项目（2009CB522703）

摘　　要：目的探讨急腹症致大肠腑实证早期器官损害的特征及防治方法，总结早期器官功能损害的发展变化规律及防治经验，为正确判断疾病预后和中西医结合综合治疗提供临床依据。方法回顾性分析2009年8月至2013年7月天津市南开医院收治的资料完整的91例急腹症致大肠腑实证合并多器官功能障碍综合征（MODS）患者的临床资料，所有急腹症致大肠腑实证患者在常规西医综合治疗基础上加用通里攻下药物清肺承气颗粒治疗（主要成分为瓜蒌、厚朴、半夏、大黄、枳实、黄连）。患者入科后立即给予相关监测，依据MODS标准诊断程序，统计患者早期（人科后1、3、7和14d）各器官功能障碍的发生率，用Pearson相关性分析法分析急腹症大肠腑实证器官损害数目与急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、14d病死率及APACHEⅡ评分与14d病死率的相关性。采用非条件多因素logistic回归分析急腹症致大肠腑实证死亡的独立危险因素。结果本组91例患者胃肠道普遍受累，器官功能损害发生率从高到低依次为：胃肠道、肺、心、代谢、肾、肝、外周循环、凝血、脑，发生率分别为96．70％（88／91）、85．71％（78／91）、57．14％（52／91）、56．04％（51／91）、27．47％（25／91）、23．08％（21／91）、20．88％（19／91）、10．10％（10／91）、8．79％（8／91）。严重并发症以急性呼吸窘迫综合征（ARDS）最多见（31例、34．07％），其次为休克（19例、20．88％），肝功损害（15例、16．48％），消化道出血（13例、14．29％），肾衰竭（12例、13．19％），凝血功能异常（10例、10．99％），胰腺脑病（8例、8．79％），发生时间无明显差异，多集中在人院前7d内。急腹症致大肠腑实证患者入院1、3、7d累积器官数目与APACHEⅡ评分呈正相关（r分别为0．358、0.240、0．283，�Objective To discuss the characteristics of organ damages at early stage in dachang fushi syndrome induced by acute abdomen and their methods of prevention and treatment, and summarize the pattern of developmental changes of organ functional impairments at early stage and the experiences in their prevention and treatment to provide clinical basis for correctly judging the prognosis and applying integrated Chinese and western medicine treatment. Methods Ninety-one patients with complete historical data of dachang fushi syndrome induced by acute abdomen eomplicated with muhiple organ dysfunction syndrome （MODS） and admitted into Tianjin Nankai Hospital from August 2009 to July 2013 were retrospectively analyzed. All the patients with dachang fushi syndrome received conventional western medicine comprehensive therapy and traditional Chinese medicine for freeing the interior and offensive treatment that was qing feichengqi granule [the main components： fruit, magnolia bark, tuber, rhubarb, citrus aurantium, rhizome coptidis]. After admission into the department, the patients were immediately given related monitoring. According to the MODS standard diagnostic procedures, the incidences of various organ dysfunctions at early stage （after admission for 1, 3, 7 and 14 days） were recorded. Correlation between the number of gastrointestinal tract damage and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score, 14 days mortality, APACHE Ⅱ score and 14 days mortality were analyzed by Pearson correlation analyzation method. The unconditional multivariate logistic regression analysis was used to analyze the independent risk factors of death of dachang fushi syndrome caused by acute abdomen. Results In this group, the gastrointestinal tract damage was generally involved in 91 patients; the sequence of rates of organ functional damage from high to low order was as follows： gastrointestinal tract, lung, heart, metabolism, kidney, liver, peripheral blood circulation, blood coagulation and brain,

关 键 词：大肠腑实证 多器官功能障碍综合征 器官损害 危险因素 中西医结合 

分 类 号：R722.12[医药卫生—儿科]