重症急性胆管炎并发多系统器官衰竭29例临床分析

目的:为探讨重症急性胆管炎(ACST)并发多系统器官衰竭(MSOF)病人的病情发展规律和临床特点,为其救治提供理论依据。方法:按Carrico等标准纳入1974—1992年收治的ACST并发MSOF患者29例,进行临床分析,并用卡方检验进行统计学处理。结果:ACST并发MSOF的发生率为42％(29/69)。ACST患者死亡由于MSOF者占88％,为ACST患者致死的最主要原因,其病死率与受累器官的数目呈正比,单器官衰竭者的病死率为14.9％,3器官衰竭者为83.3％,而≥4器官者全部死亡。最易受波及的器官是肝脏(21/29,71.4％),病死率最高的是肾功能衰竭(12/13,92.3％)。伴有休克的ACST患者MSOF的发生率(63.3％)明显高于无休克者(22.2％)。结论:临床上注意保护肝、肾等器官功能,及时纠正休克,有效地控制单器官衰竭向多系统器官衰竭的发展是降低病死率的重要环节。

Clinical analysis of 29 patients with acute cholangitis of severe type with multiple system organ failure

AIM To provide the theoretical basis for clinical treatment,the development and clinical characteristics of acute cholangitis of severetype(ACST)associated with multiple system organ failure(MSOF)were studied.METHODS According to the criteria of Carrico et al,from 1974 to 1992,29 patients with ACST associated with MSOF wereclinically analysed,and Chi-Squate test was used in statistical analysis.RESULTS The incidence of ACST associated with MSOF was 42%(29/69).The patients with ACST died of MSOF had amortality of 88%.MSOF was the most important cause of death in patients with ACST.There was a positive correlation betweenthe mortality and the numbers of attacked organs.Patients with only one organ faliure had a mortality of 14.9%,and the mortalityof patients with three organs faliure was 83.3%,and further the patients with four or more organs failure were all dead.The mostsusceptible organ was liver(21/29,74.4%).Patients with acute renal failure had the highest mortality(12/13,92.3%).Theincidence of MSOF in patients with shock(63.3%)was higher than those without shock(22.2%).CONCLUSIONS In lowering mortality for patients with ACST,it is important to protect liver and renal function from injury,correct shock promptly and stop developing from one organ failure to MSOF.