新生儿危重疾病时循环衰竭与胃肠功能障碍的相关性探讨

新生儿危重疾病时在原发疾病基础上易发生多系统器官功能障碍或衰竭。循环衰竭尤其是难治性休克是疾病发展恶化的重要环节 ,直接影响着预后 [1 ] 。大量的临床实验证明 ,腹胀是休克恶化的重要标志[2 ] 。本文分析 1992年 1月～ 1999年10月我院收治的 38例新生儿危重病例资料 ,旨在探讨新生儿危重疾病时循环衰竭与胃肠功能障碍的相关性。1　临床资料1.1　一般资料　危重症新生儿 38例 ,男 2 8例 ,女 10例。同时符合以下条件 :1严重腹胀和 (或 )吐咖啡色液体 ;2循环衰竭 :表现有肢凉、皮肤发花、尿少或体温不升、毛细血管充盈时间在 3秒以上。…     

新生儿胃肠功能障碍临床分析

目的对患有胃肠功能障碍的新生儿症状表现和治疗的临床效果进行研究分析。方法抽取76例患有胃肠功能障碍的新生儿病例,将其分为A、B两组,每组38例。分别采用红霉素和红霉素与金双歧联合的方法进行治疗。结果 B组患儿的临床治疗效果明显优于A组患儿,相关症状消失时间明显短于A组,B组治疗后出现复发例数明显少于A组。两组患儿在治疗过程中均未出现严重的并发症和不良反应。结论采用红霉素与金双歧联合的方法对患有胃肠功能障碍的新生儿进行治疗的临床效果非常理想。     

新生儿窒息后胃肠功能障碍的临床分析

目的 了解新生儿窒息并发胃肠功能障碍的临床特点,提高该病诊断与治疗水平.方法 对168例新生儿窒息引起胃肠功能障碍的43例患儿进行回顾性分析.结果 新生儿窒息引起胃肠功能障碍的发生率为26.0%,仅次于脑、肾损害的发生率(68.5%、41.1%).其中轻度胃肠功能障碍占72.1%,重度胃肠功能障碍占27.9%.早期临床表现以食欲差、拒奶、频繁呕吐、轻度腹胀及肠鸣音减弱等为主,晚期临床表现为肠鸣音消失、高度腹胀.胃肠功能障碍治疗有效率为83.7%.结论 对窒息新生儿应警惕胃肠功能障碍,应早诊断、早治疗,预防多器官功能衰竭综合征发生,降低病死率.     

危重病胃肠功能障碍中医证型探讨

危重患者抢救中,胃肠功能尽快恢复对提高抢救成功率起重要作用,胃肠营养是其关键环节及预后。《千金方》曰:“胃为水谷之海,五脏六腑之大源,多气多血之冲乃吉生死之悠关。”祖国医学早已认识到胃肠功能障碍在危重病的发生过程中起关键作用。虽然对胃肠道内毒素及肠道菌群移位等     

新生儿胃肠功能障碍68例临床分析

新生儿胃肠功能障碍是高危儿常见的并发症 ,一旦出现提示病情较重。如何促进胃肠功能恢复是提高危重患儿抢救成功率的关键。我科 (作者原工作在台州市立医院儿科 ) 1996年6月～ 2 0 0 3年 6月收治新生儿胃肠功能障碍 68例 ,现将临床资料分析如下。1　资料与方法1 1　一般资料 :男 46例 ,女 2 2例 ;足月儿 5 3例 ,早产儿、低出生体重儿 15例 (孕周 3 2～ 3 6周 )。原发病为新生儿窒息2 8例 ,缺氧缺血性脑病 12例 ,颅内出血 3例 ,新生儿呼吸窘迫综合征 (NRDS) 2例 ,早产儿、低出生体重儿 15例 ,肺炎 2例 ,败血症 2例 ,感染性休克 1例 ,硬肿…     

危重症新生儿胃肠功能障碍的护理干预

随着医学研究的不断发展和深入,胃肠功能障碍在危重症新生儿防治中越来越受到关注和重视。胃肠功能障碍是多器官功能障碍(MODS)的一部分,也是MODS的始发部位及促进全身MODS发展的动力器官[1]。胃肠功能障碍是导致新生儿死亡的常见原因,因此,及时发现和治疗胃肠功能障碍是危重症     

新生儿重度窒息后胃肠功能障碍防治方法探讨

目的:探讨小剂量多巴胺早期治疗对重度窒息新生儿的影响。方法:总结1993-2003年我院收治的111例重度窒息新生儿病情转归,比较胃肠功能障碍发生率。结果:两组胃肠功能障碍发生率分别为58.21%、77.27%,两者之间差异有统计学意义(χ2=4.287,P<0.05)。结论:重度窒息的新生儿尽早使用小剂量多巴胺,对降低窒息后胃肠功能损害有较好的疗效。     

危重病患者胃肠功能障碍与预后关系的临床研究

目的 探讨危重病患者胃肠功能障碍与预后之间的关系。方法回顾性分析300例危重病患者临床资料，将其分为胃肠功能障碍组（181例）和非胃肠功能障碍组（119例）。分析胃肠功能障碍与急性生理和慢性健康（APACHEⅡ）评分、多器官功能障碍综合征（MODS）及预后之间的关系。结果综合性重症监护病房内患者胃肠功能障碍的发病率为60．3％。胃肠功能障碍组APACHEⅡ评分、MODS发生率和病死率较非胃肠功能障碍组均明显升高（均为P〈0．05）。结论危重病患者胃肠功能障碍提示病情严重和预后不良。要重视胃肠功能障碍的预防和早期治疗。     

新生儿窒息后胃液pH与胃肠功能障碍关系

新生儿窒息是围产期常见的急症,窒息缺氧导致多脏器功能损害是引起死亡的重要原因,而胃肠道在其发展过程中具有重要作用,被认为是多脏器功能衰竭的始动器官,胃肠功能障碍的出现常提示病情加重,预后不良。因此早发现、早处理是防止病情发展、减少死亡的关键。我们对46例窒息新生儿胃液pH值进行动态监测。现报道如下。     

小儿危重病与胃肠功能衰竭的关系—附68例报告

目的：探讨小儿危重病与胃肠功能衰竭的关系。方法：对68例危重病儿的临床资料进行回顾性分析,评估疾病严重程度、多器官功能衰竭（MOF）与胃肠功能衰竭的关系。结果：68例危重病儿中单项危重病15例（均无MOF）、多项危重病53例（其中危重25例,极危重28例）;53例中5例为单器官功能衰竭,余48例为伴MOF者。胃肠功能衰竭发生率在伴MOF的危重病儿组为60％（29／48）,单项危重组为7％（1／15）,两组比较有显著性差异（P＜0．05）。胃肠功能衰竭发生率在危重病评分的不同评分组依次为：A组（60分以下）100％,B组（60分－70分）68％,C组（71分－80分）24％;具有1,2,3,4个或以上器官衰竭的患儿,胃肠功能衰竭发生率依次为：0,0,63％,83％,均有显著性差异（P＜0．05,P＜0．01）。结论：伴MOF的危重病儿胃肠功能衰竭发生率高,危重病评分分值越低,受损器官越多,功能衰竭发生率越高,应予高度重视并予早期干预。     

危重病患者多器官功能障碍综合征细胞因子变化的意义

目的：探讨肿瘤坏死因子－α（TNF－α）、白细胞介素1β（IL－1β）、白细胞介素6（IL－6）、白细胞介素8（IL－8）、白细胞介素10（IL－10）在危重病多器官功能障碍综合征（MODS）病理过程中的作用及其临床意义。方法：采用酶联免疫吸附（ELISA）法检测48例不同类型的危重病患者血清TNF－α、IL－1β、IL－6、IL－8、IL－10的含量,并分析36例MODS患者器官衰竭数与死亡率的关系。结果：MODS组与非MODS组血清TNF－α、IL－1β、IL－6、IL－8、IL－10含量水平均较对照组明显升高,尤以MODS组最为明显（P＜0．01）,且IL－6、IL－8、IL－10峰值升高时限滞后于TNF－α、IL－1β,IL－10升高最晚。MODS组36例患者二脏衰死亡率为54．5％,三脏衰为80％,≥四脏衰为100％。结论：细胞因子TNF－α、IL－1β、IL－6、IL－8、IL－10的异常释放可能参与了危重病MODS的病理过程,MODS的病死率与脏器衰竭数呈正相关。     

危重病患者全身炎症反应综合征和多器官功能障碍综合征

目的　提高对危重病患者发生全身炎症反应综合征 (SIRS)和多器官功能障碍综合征 (MODS)的认识。方法　分析 2 89例SIRS患者的临床资料 ,病人至少符合 2个SIRS标准 ,包括发热、体温过低、心动过速、呼吸急促或白细胞计数异常 ;MODS则符合各器官功能标准 ,而且在机体遭受打击 2 4小时后序贯出现两个或两个以上器官功能不全。结果　符合SIRS的危重病患者 2 89例 ,其中符合 2项标准者 75例 (2 5 9% ) ,3项者 10 4例 (36 0 % ) ,4项者 110例 (38 1% )。SIRS发展为MODS者2 0 3例 (70 2 % ) ,其中SIRS 2项者 5 4例 (2 6 6 % ) ,3项者 78例 (38 4% ) ,4项者 71例 (35 0 % )。死亡 15 0例 (73 9% ) ,其中SIRS2项者 38例 (2 5 3% ) ,3项者 5 9例 (39 3% ) ,4项者 5 3例 (35 3% ) ;二脏衰死亡 2 6例 (42 6 % ) ,三脏衰死亡 5 0例 (74 6 % ) ,四脏衰死亡 41例 (95 3% ) ,≥五脏衰死亡 33例 (10 0 0 % )。结论　SIRS可由细菌感染或非感染性疾病引起 ,且均能导致MODS ,阻断前炎症细胞因子和肿瘤坏死因子 -a的效应 ,对SIRS的发生有预防价值 ,可望降低MODS的发生。     

血液净化技术在危重病人急性肾功能衰竭中的应用

目的：总结危重病人急性肾功能衰竭（ARF）血液净化治疗的经验。方法：采用血液透析（HD）治疗者69例,持续性非卧床腹透析（CAPD）治疗者45例,连续性动静脉血液滤过（CAVH）治疗者2例。结果：应用HD治疗者69例,治愈52例（75．4％）,死亡17例;应用CAPD治疗者45例,治愈32例（71．1％）,死亡13例;HD和CAPD两种透析方法,治愈率和病死率两者之间差异均无显著性（P＞0．05）;应用CAVH治疗者2例,死亡1例,死于多器官功能障碍综合征（MODS）。结：血液净化技术是治疗危重病人ARF的重要措施之一,但必须注意综合治疗,在积极治疗原发性疾病的基础上,加强对重要脏器功能的监测,正确评估和对其它“易衰竭器官”进行保护,以防止MODS的发生,对降低危重病患者ARF病死率有重要意义。     

Validation of the multiple organ dysfunction (MOD) score in critically ill medical and surgical patients

Objective To validate the Multiple Organ Dysfunction (MOD) score externally.Design Prospective observational cohort study.Setting Mixed medical/surgical ICU in a tertiary referral university hospital.Patients and participants Thousand eight hundred and nine patients admitted to ICU for more than 24 h over a 3-year period.Interventions None.Measurements and results The MOD score was calculated daily for all patients. The criterion validity of the individual organ scores, the maximal MOD score and the change in MOD score were assessed by examining the relationship between increasing scores and ICU mortality. Increased maximal MOD scores and each of the six individual organ scores, and change in MOD scores were associated with increased mortality.Conclusions Maximal and individual organ scores have criterion validity when tested in a different ICU from that in which the scores were derived, indicating that the scoring systems are reproducible. The association of change in MOD score with mortality indicates that the score is responsive. These data, combined with previous data establishing concept and content validity, indicate that the MOD score is a valid measure of multi-organ dysfunction.     

新生儿多器官功能不全综合征临床研究

目的了解新生儿多脏器功能不全综合征( MODS)的预后及相关因素.方法回顾性分析我院 1999年 1月～ 2001年 12月收治的危重新生儿, MODS诊断参考全国小儿急诊学组拟定 MOF诊断标准.结果全组 252例危重儿, 137例出现程度不等的器官功能损害, 84例为 MODS,死亡 32例, MODS死亡率 38.1% (32/84).发生肺、心、脑、胃肠道、肾、肝及血液方面功能不全构成比及相关病死率分别为 32.1%、 20.6%、 15.7%、 13.2%、 11.1%、 5.6%、 1.7%和 26.1%、 30.5%、 35.6%、 13.2%、 62.5%、 18.8%、 60.0%. 1～ 5个器官功能不全时病死率分别为 1.8%、 15.0%、 41.7%、 77.8%、 100%, P<0.05.产伤、严重窒息、早产儿及胎粪羊水污染者易发 MODS.结论 MODS 在 NICU中发生率及病死率均高,预后与发生衰竭器官的严重度、数目有关,围产因素影响 MODS的发生,故提倡围产保健,早期有效干预治疗.     

Effects of early treatment with immunoglobulin on critical illness polyneuropathy following multiple organ failure and gram-negative sepsis

Objective: The evaluation of incidences and relating factors of severe persisting critical illness polyneuropathy (CIP) in survivors of multiple organ failure (MOF). Design: Prospective study with an entry period of 24 months. Electrophysiological studies for the diagnosis of CIP were performed 1 or 2 days before the patients were discharged from the intensive care unit (ICU). Factors which might have been related to the development of CIP were identified by a retrospective chart analysis. Setting: The interdisciplinary ICU of a university hospital. Patients: Thirty-three patients who survived MOF. Sixteen of these critically ill patients developed severe sepsis due to nosocomial infections with gram-negative bacteria. Results: In seven survivors of MOF and sepsis typical electrophysiological features of CIP, like spontaneous fibrillations and low compound muscle action potentials, were detectable at the time of discharge from the ICU. Seventeen patients with MOF following multiple trauma who developed no sepsis, and nine survivors of MOF with sepsis showed no signs of persisting CIP at the end of their ICU stay. Chart analysis revealed that eight survivors of MOF with sepsis and without the development of CIP had been treated with intravenous immunoglobulin (IVIG) with a dosage of 0.3 g/kg per day for 3 days immediately (within 24 h) after the diagnosis of sepsis. Four out of seven patients with MOF and sepsis who developed CIP were transferred to our ICU after the onset of sepsis and had not received IVIG treatment. The IVIG treatment in three patients was delayed for more than 24 h after the diagnosis of sepsis and was then omitted. Obviously not related to the development of CIP were aminoglycoside antibiotics, steroids, nutritional disturbances and episodes of hypotension or hypoxia. Neuromuscular blocking agents were not used during intensive care treatment. Conclusions: A high incidence of severe CIP persisting until the day of discharge from the ICU was related to gram-negative sepsis but not to MOF alone. Retrospective chart analysis suggested that early application of IVIG may prevent or mitigate this severe complication. However, these results have to be confirmed in a prospective, placebo-controlled study. Received: 22 April 1997 Accepted: 17 September 1997     

源于胃肠道感染的小儿脓毒性休克及多器官功能障碍综合征

目的分析以胃肠道感染起病的小儿脓毒性休克及多器官功能障碍综合征衰竭(MODS MOF)的临床特征、病因及转归。方法总结2000年1月至2004年12月收治的28例患儿,在胃肠道感染发病后,发生脓毒性休克及MODS MOF的临床特征、死亡影响因素。结果28例患儿中,21例死亡,病死率为75%。年龄(1.9±3.4)岁,19例(67.8%)小于1岁。累及(3.7±0.9)个器官,发病至出现首个系统或器官功能障碍时间为(39.4±24)h。受累脏器频度依次为循环系统28例(100%)、胃肠道21例(75%)、肺20例(71.4%)、肾14例(50%)、脑9例(32.4%)、血液9例(32.4%)、肝5例(17.9%)。最早出现障碍的器官分别是胃肠道13例(46.4%),循环系统11例(39.3%),肺4例(14.3%)。容量复苏1h内液量30～75ml kg,(46.2±12.6)ml kg;6h内输液量70～120ml kg,(92.7±33.9)ml kg。6h内达到和未达复苏目标(EGDT)者病死率分别为66.7%和90.0%。合并器官衰竭数目和危重评分值与病死关系有显著性(P<0.05或P<0.01)。结论小儿源于胃肠道感染后的MODS MOF,发病年龄小,病情进展迅速,病死率高;容量复苏液体需要量大,6h达到复苏目的者预后较好。     

Association of cell-free plasma DNA with hospital mortality and organ dysfunction in intensive care unit patients

Objective To investigate the concentration of cell-free plasma DNA and its association with organ dysfunction and hospital mortality in intensive care unit patients. Design and setting Prospective cohort study in a medical and two medical-surgical intensive care units in a university hospital. Patients 228 critically ill patients admitted to the ICUs between January 2004 and July 2005. Measurements and results Blood samples were collected as soon as possible after ICU admission, the following morning, and 48 h after the second sample. The cell-free plasma DNA was measured by real-time quantitative PCR assay for the β-globin gene. Physiological and mortality data were collected to the clinical database. Hospital mortality rate and SOFA scores were primary outcome measures. The maximum plasma DNA concentrations were correlated significantly with APACHE II points and with maximum SOFA scores. Cell-free plasma DNA concentrations were higher in hospital non-survivors than in survivors (median 9,366 vs. 6,506 GE/ml). Using logistic regression analysis, the maximum plasma DNA was an independent predictor of hospital mortality. Conclusions The maximum plasma DNA concentration measured during the first 96 h of intensive care is associated with the degree of organ dysfunction and disease severity. Moreover, the maximum DNA concentration is independently associated with hospital mortality. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.