腹部外科疾病并发MODS时的临床特点及中西医结合治疗研究  

Combined treatment of abdominal dis-eases with MODS by Chinese medicine

作　　者：岳茂兴[1] 

机构地区：[1]中国人民解放军第306医院普通外科,北京市100101

出　　处：《世界华人消化杂志》2002年第8期937-941,共5页World Chinese Journal of Digestology

摘　　要：目的:多器官功能障碍及衰竭目前还没有好的治疗手段,本研究探索降低腹部外科疾病并发MODS患者死亡率的中西医结合综合救治应对新策略措施.方法:从1982/2000年共收治的腹部外科疾病并发MODS患者123例均为住院患者.男75例,女48例,年龄8-93(平均53.4±0.4)岁.(1)提出了短程大剂量联合应用山莨菪碱、地塞米松为主的综合救治方案;(2)整体治疗MODS时,在“炎性递质、细菌、内外毒素、微循环、免疫功能、营养代谢、基础疾病、脏器功能”等方面进行兼顾和并治,并相应实施10条具体治疗措施.有机地把整体观和具体治疗措施相结合,使得救治效果更佳;(3)针对MODS时,一方面机体处在高代谢状态,急需给予补充;另一方面器官功能障碍,不能有效地利用营养素及排出代谢产物.提出并应用了“分阶段代谢营养支持”及“免疫营养支持”治疗,减少了严重并发症的发生率;(4)采用自制的“解毒固本汤”配合治疗,以改善免疫紊乱状态、调控炎性递质等.结果:按KnausWA教授MODS的诊断标准,123例中共死亡59例,死亡率为48.0%.其中应用传统常规疗法的88例,死亡49例,死亡率为55.7%.采用中西医结合综合救治应对新策略疗法的35例中,共死亡10例,死亡率为28.6%.结论:MODS及MOF病因复杂,治疗困难,死亡率高,采用中西医结合综合救治应对新策略疗法能降低MODS及MOF的死亡率.ALM: To explore treatment methods for abdominal surgi-cal diseases complicated with MODS to reduce the deathrate of the patients.METHODS:Total 123 cases of MODS patients were in-cluded in this study. There were 75 male and 48 femalewith average age of 53.4 years (ranged from 8 - 93 years).Combined treatment measures were used, including a largedosage of anisodaminum and dexamethasone for a shorttime. To take MODS as an entity, the authors paid moreattention to inflammatory factors, bacteria, exotoxin andendotoxin, immunity, dysfunction of microcirculation, nutri-tion and metabolism, chronic diseases, and the function oforgans. Accordingly, 10 general measures were applied inthe treatment with better results. Under the situation ofMODS, the body was at the condition of high metabolismon the one hand, and needed to be supported, but on theother hand, the organs were at poor conditions and notable to effectively use nutriment and transpire metabolismproduction. Therefore, the authors presented a nourishmentsupport according to different grades of the diseases andimmuonutrition therapy was used to reduce the happeningrate of serious syndrome. Jiedugubentang, a Chinese medi-cine recipe, was developed to improve immunologic stateand adjust the deliverance of inflammatory factors in thepatients.RESULTS:According to the diagnostic standard of MODSproposed by Professor Knaus, there were 59 patients diedin 123 patients, with a mortality being 48.0%, in which 49of the 88 patients who were treated with traditional routinemethods were died, with a mortality of 55.7%, and 10 ofthe 35 patients who were treated with combined therapieswere died, with a mortality of 28.6%.CONCLUSIONS:MODS and MOF have complicated patho-genesis and are difficult to be cured with a high mortality.The mortality of MODS and MOF can be cut down by usingthe new combined therapies.

关 键 词：腹部外科疾病 MODS 临床特点 多器官功能障碍 中西医结合疗法 

分 类 号：R656[医药卫生—外科学] R59[医药卫生—临床医学]