老年脑出血并发多器官衰竭64例临床分析

老年人随着年龄的增长 ,各器官储备功能不断降低 ,在某种应激条件下 ,很易出现老年多器官衰竭。脑出血合并老年多器官衰竭是造成患者死亡的重要原因。现将我院 1996年1月至 2 0 0 2年 1月 6年间收治的 6 4例病例做一分析。1　临床资料1.1　一般资料　本组 6 4例中 ,男 39例 ,女 2 5例 ,年龄 6 0～86岁 ,平均 (71± 10 )岁。既往有高血压病史 5 0例 ,起病时血压高于正常者 6 2例 ;有脑卒中病史者 18例 ;有糖尿病病史者12例 ;冠心病病史者 6例 ;慢性支气管炎病史 7例。脑叶出血 5例 ,基底节区出血 30例 ,脑干出血 9例 ,丘脑出血 14例 ,小脑出…     

产科多器官功能衰竭22例临床分析

目的：探讨产科多器官功能衰竭的诊断及防治。方法：通过对22例产科多器官功能衰竭的临床资料进行回顾，分析其发病原因、病人及其新生儿结局和产科多器官功能衰竭的防治方法。结果：导致产科多器官功能衰竭的主要原因为产后出血，器官衰竭以凝血功能障碍最常见，亦以其为最常见的启动器官。结论：及时处理多器官功能衰竭的病因，积极预防及治疗产后出血，果断进行剖宫产及子宫切除，是减少产科多器官功能衰竭患者死亡的关键。     

妊娠并多系统器官功能衰竭综合症临床分析

目的:了解妊娠合并多系统器官功能衰竭综合症(MODS)发病的特点、诱因和治疗方法.方法:对1992年2月至2008年2月收治的34例妊娠合并MODS的病例进行回顾性分析.结果:本组34例的诱因主要为妊娠高血压综合征、产后出血、妊娠合并内科疾病、羊水栓塞等;32例治愈,2例死亡.结论:控制诱因的发展,是妊娠合并MODS取得治疗成功的前提,适时终止妊娠及选择正确的分娩方式有利于疾病的治疗,多学科合作,保护与支持各器官功能,是救治成功的关键.     

小儿多系统器官功能衰竭

小儿多系统器官功能衰竭赵祥文多系统器官功能衰竭（ＭｕｌｔｉｐｌｅＳｙｓｔｅｍＯｒ－ｇａｎＦａｉｌｕｒｅ．ＭＳＯＦ）是指多个系统或器官，同时或序贯地发生功能衰竭而出现的临床综合征。常发生于严重感染、感染性休克和外科创伤等原发疾病的基础上。近年来由于监护...     

儿童营养不良并发多系统器官功能衰竭80例分析与护理

我院于1999～2003年收治营养不良并发多系统器官功能损害患儿80例，现将分析及护理总结如下。     

多系统器官功能衰竭与败血症

进修医生多系统器官功能衰竭（MSOF）的概念已提出20余年,近年来有关MSOF的研究进展较快,请老师介绍一下有关资料。教授MSOF是各种严重感染、创伤与大手术后的主要死亡原因。临床一旦出现MSOF,抢救往往困难,尤其是三个脏器以上功能衰竭时,病死率仍然很高。MSOF的发病机制相当复杂。90年代初,美国危重病急救医学会（SCCM）提出了全身世炎症反应综合征（SIRS）的名词。并认为MSOF的发病规律可理解为：先从SIRS演变为多器官功能不全综合征（MODS）,再发展为MSOF。临床分期为：①功能受损或;②衰竭早期;③衰竭期。因…     

产科多器官功能衰竭17例临床分析

目的 探讨产科患者多器官功能衰竭(MOF)的临床诊断及处理.方法 对17例MOF病例的临床资料进行回顾性分析.结果 17例多器官功能衰竭的主要诱因是产后出血、重度妊娠期高血压疾病、羊水栓塞、胎盘早剥.器官功能障碍以凝血功能障碍及肾功能衰竭为最多见.8例死亡,病死率47.06%.结论 预防和治疗原发病,积极去除病因,早期诊断及治疗凝血功能障碍及肾功能衰竭,是降低MOF病死率的关键.     

小儿重型颅脑损伤合并多器官衰竭的病情评估

按照《婴儿及儿童多系统器官衰竭诊断标准的建议》〔1〕,对我院1999年11月—2 0 0 3年11月收治的30例重型颅脑损伤合并2个以上器官衰竭患儿进行分析,总结如下。1　临床资料1.1　病例:30例患儿中男性18例,女性12例;年龄0～5岁4例,≥5～10岁12例,≥10～14岁14例,平均9.5岁。昏迷2 6例(其中深昏迷12例,中度昏迷14例) ,意识恍惚4例;呕吐2 2例;抽搐2 0例;瞳孔改变2 1例(一侧散大10例,双侧散大6例,大小多变5例) ;颅神经损害2 3例;合并伤7例(肺挫伤3例,脾破裂1例,股骨干骨折2例,骨盆骨折1例)。2 8例行头颅CT检查,其中硬膜外或硬膜下血肿6例,脑内血…     

急性弥漫性腹膜炎并发多器官衰竭21例分析

198 3年以来 ,我院诊治弥漫性腹膜炎 2 87例 ,其中并发多器官功能衰竭 (ＭＯＦ) 2 1例 ,占7 32 % ,现报告如下。1　临床资料本组 2 1例 ,死亡 6例 ( 2 8 57% )。其中男 1 3例 ,女 8例 ,年龄 31～ 84岁。 >60岁组ＭＯＦ发生率高达 1 6 42 % ,病死率为 45 45% ( 5/1 1 )。脏器功能衰竭发生的顺序为肺 ( 65 3% )、肾脏( 51 2 % )、肝脏 ( 4 4 4% )、循环系统 ( 2 8 9% )、脑功能不全 ( 72 4% ) ,其次为ＤＩＣ等。急性弥漫性腹膜炎的病因见表 1。表 1　急性弥漫性腹膜炎原发病情况原发疾病 低温灌洗组(ｎ =15 8)非低温灌洗组(ｎ =12 9)腹内脏…     

Predictors of mortality and multiple organ failure in children with sepsis

Objectives: To assess the markers of perfusion which best discriminate survivors from non-survivors of childhood sepsis and to compare the information derived from gastric tonometry with conventionally measured haemodynamic and laboratory parameters. Design: Prospective clinical study of children with sepsis syndrome or septic shock. Setting: Paediatric intensive care unit in a tertiary referral centre. Patients: 31 children with sepsis syndrome or septic shock. Interventions: A tonometer was passed into the stomach via the orogastric route. Measurements and main results: The following data were recorded at admission, 12, 24 and 48 h: heart rate, mean arterial pressure, arterial pH, base deficit, arterial lactate, gastric intramucosal pH (pHi) and DCO₂ (intramucosal carbon dioxide tension minus arterial partial pressure of carbon dioxide). The principal outcome measure was survival. The secondary outcome measure was the number of organ systems failing at 48 h after admission. There were 10 deaths and 21 survivors. No variable discriminated survival from death at presentation. Blood lactate level was the earliest discriminator of survival. Using univariate logistic regression, lactate discriminated survivors from those who died at 12 and 24 h after admission, but not at 48 h (p = 0.049, 0.044 and 0.062, respectively). The area under the receiver operating characteristic (ROC) curve for lactate was 0.81, 0.88 and 0.89 at 12, 24 and 48 h, respectively. At 12 h after admission, a blood lactate level > 3 mmol/l had a positive predictive value for death of 56 % and a lactate level of 3 mmol/l or less had a positive predictive value for survival of 84 %. At 24 h a lactate level > 3 mmol/l had a positive predictive value for death of 71 % and a level of 3 mmol/l or less had a positive predictive value for survival of 86 %. No other variable identified non-survivors from survivors at 12 h. Gastric tonometry could only be done on 19 of the 31 children, of whom 8 died and 11 survived. In these 19 children, DCO₂ measured at 24 h, but not at 12 or 48 h, distinguished those who died from those who survived (p = 0.045 and p = 0.20, respectively). The area under the ROC curve for DCO₂ measured at 24 h as a predictor of survival was 0.71. Neither the absolute value of pHi nor the trend of change in pHi at any time in the first 48 h identified survivors in this series. The mean arterial pressure distinguished survivors from non-survivors at 24 and 48 h (area under ROC curve = 0.80 and 0.78, respectively). The base deficit and heart rate did not identify non-survivors from survivors at any time in the first 48 h. Conclusions: Blood lactate level was the earliest predictor of outcome in children with sepsis. In this group of patients, gastric tonometry added little to the clinical information that could be derived more simply by other means. Received: 19 September 1996 Accepted: 20 February 1997     

40例多器官衰竭时急性肾功能衰竭的临床分析

目的：探讨多器官衰竭（ＭＯＦ）时急性肾功能衰竭（ＡＲＦ）的更为有效的防治手段，防止和阻断其进一步发展，改善ＭＯＦ的预后。方法：对４０例ＭＯＦ合并ＡＲＦ的病例资料进行临床分析。结果：ＭＯＦ的主要原发病因是感染（７０．０％），其次是创伤（２２．５％），其它占７．５％；本组患者的病死率６５．０％，且随衰竭器官的数目增多而病死率升高。ＡＲＦ表现为少尿型８７．５％，非少尿型１２．５％。采用血液透析（ＨＤ）治疗２２例中存活１２例，死亡１０例，病死率５４．５％；非ＨＤ治疗１８例中存活２例，死亡１６例，病死率８８．９％，比较此两种治疗方法的疗效ＨＤ组明显高于非ＨＤ组（Ｐ＜０．０１）。结论：对于ＭＯＦ时ＡＲＦ的治疗，首先应针对各器官衰竭的治疗；积极有效地控制感染是抢救成功的关键；早期充分的血液净化是治疗的重要环节；辅助支持疗法，提高免疫功能，改善组织缺氧，禁止应用对肾脏有损害的药物，对改善本病的预后具有重要意义。     

脑出血继发多器官功能衰竭76例临床分析

目的 :探讨脑出血继发多器官功能衰竭 (MOF)的病因及防治措施。方法 :收集继发MOF病例 76例 ,与同期无MOF的 2 40例脑出血相对照 ,从病死率、发病年龄、发病机理等方面进行分析。结果 :MOF组病死率 61 8% ,而同期无MOF者 2 40例脑出血病死率为 5 42 % (P <0 0 1)。且脏器衰竭数目越多 ,病死率越高 ,高龄、有慢性疾病、意识障碍严重、脑出血量大者易并发MOF。结论 :MOF是脑出血死亡的重要原因之一 ,在防止脑功能衰竭的同时要积极治疗其它慢性基础疾病     

老年重症肺炎并发多器官功能衰竭患者临床危险因素分析

目的分析老年重症肺炎并发多器官功能衰竭患者的临床危险因素、治疗以及转归等。方法回顾73例老年重症肺炎并发多器官功能衰竭患者的临床资料,分析这些患者的相关化验指标、危险因素以及转归等。包括体重质量指数、白蛋白水平、血细胞比容、APACHEII评分、机械通气治疗、肺部感染评分等指标。结果临床肺部感染评分大于6分组患者的病死率高于小于6分组患者;未接受机械通气组患者病死率大于接受机械通气治疗组患者;A-PACHEII评分大于30分组患者的病死率大于小于30分组患者;存活组与死亡组患者的白蛋白水平、血细胞比容、体质量指数等无统计学差异。结论I临床肺部感染评分、APACHEII是预测老年重症肺炎并发多器官功能衰竭患者病死率非常重要的治疗,值得在,临床进一步推广。     

Postoperative multiple organ failure

Cellular damage is the pathophysiologic basis for the postoperative multiple organ failure syndrome. This damage may be caused by pre- and intraoperative shock. Postoperative organ failure is manifested when cellular repair does not occur. Three factors may contribute to this progression to multiple organ failure: inadequate resuscitation, malnutrition, and sepsis.     

以多器官功能衰竭为表现的噬血细胞综合征25例分析

目的分析和总结以发热伴有多器官功能衰竭为主要表现的噬血细胞综合征患者的临床特点,以期对该病能够提高意识,尽早寻找证据进行诊治。 方法回顾性分析2014年5月至2017年12月因发热伴有多器官功能衰竭入住内科ICU的25例噬血细胞综合征患者的临床资料,对其诊断、器官受累情况、实验室检查及预后进行分析。 结果25例患者中,男16例,女9例,平均年龄（38.32±15.80）岁。所有患者均符合HLH-2004诊断标准,其中6例确诊淋巴瘤,EB病毒感染3例,系统性红斑狼疮3例,白血病2例,巨细胞病毒感染1例,真菌感染2例,腺病毒感染1例,镉中毒1例,余6例病因未明。患者器官受累及情况：血液系统、消化系统、循环系统受累25例（100%）,呼吸系统受累20例（80%）,肾脏受累13例（52%）,中枢神经系统受累12例（48%）,乳酸升高21例（84%）。16例患者因多器官功能衰竭死亡,病死率为64%。 结论持续3周以上的发热伴有多器官功能受损,尤其以肝衰竭为主要表现者,应高度怀疑噬血细胞综合征,应积极寻找依据进行确诊,早期干预治疗,以期提高患者的生存率,待出现多器官功能衰竭后,预后差,救治成功低。     

Mediators of multiple organ failure

Multiple Organ Failure (MOF) has largely been attributed to bacterial sepsis, though conclusive evidence of an essential role for bacteria and/or their endotoxins is still lacking. On the other hand, MOF and the clinical syndrome of sepsis may be aseptically induced in germfree animals. This paper reviews the evidence that excessive activation of endogenous humoral mediators and inflammatory cells may cause this highly lethal syndrome.     

Septic shock and multiple organ failure

OBJECTIVE: To assess the frequency and mortality rates of septic shock in ICU patients and the clinical course of multiple organ failure associated with septic shock. DESIGN: Retrospective case survey. SETTING: Tertiary care center. PATIENTS: During a 2-yr period, 2,469 consecutive intensive care patients were studied regarding the frequency and hospital mortality rates of septic shock. A subset of 1,311 patients was further analyzed for the occurrence of organ system failures within 48 hrs of the onset of septic shock and again 4 to 7 days later. MEASUREMENTS AND MAIN RESULTS: The frequency rate of septic shock was 1.9% (n = 48), with a mortality rate of 72.9% (n = 35) in patients with septic shock. Deaths due to septic shock represented 14.6% of all deaths in the ICU during the study period. Eighteen patients died within 72 hrs of the onset of septic shock. Refractory hypotension was the cause of death in 15 of these 18 patients. Beyond 72 hrs, multiple organ failure accounted for eight of 17 deaths. The mean +/- SD number of organ systems failing at 48 hrs was 3.3 +/- 1.3 in survivors and 4.0 +/- 1.1 in nonsurvivors, and at 4 to 7 days was 2.1 +/- 1.5 in survivors and 4.0 +/- 1.5 in nonsurvivors (p less than .05). None of the specific organ system failures had prognostic value. The number of organ system failures was not related to the duration of hypotension, but had a weak correlation (r2 = .26, p less than .05) with the duration of vasoactive treatment at 4 to 7 days. The prolonged need for norepinephrine therapy was associated with an increased occurrence of renal failure. Thirty (62.5%) patients had positive blood cultures and a mortality rate similar to the mortality rate of patients with negative blood cultures. Patients with negative blood cultures died more often with hypotension (p less than .02). CONCLUSIONS: Septic shock is a major cause of death in intensive care patients. Refractory hypotension is a main cause of early deaths. Later on, multiple organ failure becomes the primary clinical problem and cause of mortality.