多器官功能障碍综合征的死亡危险因素分析及临床对策

目的　调查多器官功能障碍综合征 (MODS)的病死率及病死危险因素。方法　回顾性调查 1991至 1996年的 10 5 6例危重病患者 ,利用队列研究方法对MODS病死危险因素进行分析。结果　 10 5 6例危重病患者中 ,339例发生MODS ,病死率 49 3%。 1991～ 1996年 6年期间MODS病死率无明显变化 ,以年龄 ( >6 0 )和APACHEⅡ评分 ( >2 0分 )对病死率进行调整 ,调整率 6年间均无显著变化。 16个因素参与统计学分析 ,结果显示器官衰竭数目、免疫功能低下、转入时的APACHEⅡ评分、非手术、感染性休克等因素与MODS患者的病死关系显著 (P <0 0 5 )。发生 2个器官功能衰竭者病死率 17 8% ,3个器官衰竭者为 47 1% ,4个器官衰竭者为77 0 % ,而发生 5个或 5个以上器官功能衰竭者 ,病死率为 87 9%。结论　 90年代以来MODS病死率依然很高 ,充分认识MODS病死的危险因素 ,并积极调控机体炎症反应 ,防治感染性休克发生 ,可能是降低MODS病死率的关键

Multiple organ dysfunction syndrome：predictors of mortality and clinical therapeutic strategies

Objective　To study risk factors and mortality of multiple organ dysfunction syndrome（MODS） in critically ill patients．Methods　1 056 critically ill patients from 1991 to 1996 was studied retrospectively．Univariate analysis was performed to identify risk factors associated with MODS．Results　In 1 056 critically ill patients，MODS developed in 339 patients．The overall mortality of patients with MODS was 49.3%， the mortality adjusted by age（＞60） and acute physiology and chronic health evaluation APACHEⅡ score showed no significant changes during the 6 years．Univariate analysis identified the following risk factors：number of　failed organs，immunocompromise，APACHE Ⅱ score，non－operation，septic shock．Mortalities of patients with two，three，four and five failed organs were 17.8%，47.1%，77.0% and 87.9%，respectively．Conclusion　The mortality of MODS showed no trend of decline since 1990．Prevention of risk factors may play a key role in decreasing mortality of MODS in critically ill patients．