肝硬化并发多脏器功能衰竭67例治疗体会

目的：探讨肝硬化并发多脏器功能衰竭（MOF）的原因及预防措施。方法：对近10年来收治的67例肝硬化合并多脏器功能衰竭的临床资料进行分析。结果：老年组MOF的发生率、衰竭器官数目及死亡率高于非老年组，病死率与衰竭组器官数目呈正相关。结论：早期诊断，严密监护，积极有效地改善肝细胞功能，加强首衰器官的治疗，是除低MOF病死率、提高治愈率的关键。     

废气中毒致多脏器功能衰竭1例临床报告

废气中毒致多脏器功能衰竭临床上很少见有报道。1999年4月我们收治1例,并抢救成功,现简单报告如下。1 病例介绍 男,21岁,安徽人,因在密闭的发电房休息17小时之久,被他人发现昏迷5小时而拟诊急性肺水肿入院。患者入院前一天晚8时左右与同伴一道在发电房休息(其发电机燃烧汽油),次日中午1点钟左右他人发现其未正常上班工作,门前呼其不应后破门而入,发现其面色青紫、口流白沫、呼之不应,昏迷不醒(其同伴已死亡)。急诊送院抢救,给用速尿、西地兰等紧急对症处理后,急诊入科治疗。入科查体:T 36.5℃,P 130次/分,R 35次/分,BP 13/8kPa。深昏迷状态,各种深浅反射均消失。大小便失禁,双侧瞳孔等大等圆,约4mm大小,对光反射迟钝,颈项     

连续性肾脏替代治疗多脏器功能障碍综合征16例疗效分析

随着血液净化技术的不断革新 ,急性肾功能衰竭(ＡＲＦ)死亡率渐趋下降 ,但是近十年来 ,ＡＲＦ死亡率却略有上升趋势 ,合并三个脏器功能衰竭者死亡率可达85 %以上[1] ,主要原因是ＡＲＦ的原发病谱发生重大变化 ,单纯性ＡＲＦ比例下降 ,而并发多脏器功能障碍综合征 (ＭＯＤＳ)比例上升 ,以及传统血液净化技术仍有不可避免的缺陷 ,连续性肾脏替代治疗 (ＣＲＲＴ)是近年来用于治疗多脏器功能障碍综合征的一种新的方法 ,为多脏器功能障碍综合征 (ＭＯＤＳ)患者带来新的希望 ,持续性静 -静脉血液滤过 (ＣＶＶＨＦ)是最常用的一种连续性肾脏替代治…     

多脏器功能衰竭的代谢与营养支持

The problems of inflammation and infection leading to organ dysfunction and failure continue to be the major concerns after injury and operations and with the intensive care for many diseases and problems.When systemic inflammatory response syndrome (SIRS) goes to multiple organ dysfunction syndrome (MODS) and multiple organ failure (MOF),the mortality ecomes high,ranging from 30-80% depending on the number of failed organs.In MOF or MODS respiratory failure develops with the need for ventilaroty support,accompanied by circulatory instability with depression of cardiac output and a decrease in peripheral resistance,depression of the immune system,coagulation defects,gastrointestinal problems,a rising bilirubin denoting hepatic dysfunction and central nervous depression.The elevation in whole body protein turnover after sepsis and trauma usually is accompanied by an increase in metabolic rate Hepatic output of acute phase proteins rises,lean tissue is catabolized to provide energy substrates for wound and inflammatory tissue.Plasma proteins drop due to inhibition of hepathic synthesis,an increase in capillary permeability,and the dilutional effect of extracellular fluid expansion can be observed.Muscle protein synthesis seems to be decreased.These changes are driven by a combination of the counterregulatory hormones (catecholamines,glucagon,cortisol,growth hormone) and the direct and indirect actions fo the various inflammatory mediators (IL-1,IL-6,and TNF),prostaglandins and kallikreins.The changes in whole body protein turnover seen in MOF are similar to those described in overt sepsis and severe trauma:both synthesis and degradation are elevated,with a higher rate of degradation.This situation result in a loss of body mass, predominantly lean tissue.Although it is not oftern possible to identify the orgin of the “sepsis”,it must be reasonable to regard patients with MOF metabolically as “severely septic”.In recent years,the gastrointestinal tract was thought to be the ongoing inflammatory stimulus and the cause of MOF.In the presence of sepsis and shock and lack of nutrient intake,endotoxin and bacteria translocate from the lumen of the gut into the portal and systemic circulations and set up a systemic inflammatory reaction with release of inflammatory mediators.The evidence for the gastrointestinal tract as the “motor”for MOF,however,is derived largely from animal work,and the direct evidence duppotyinh gut permeability as a cause of MOF in man is less convincing,although early and aggressive enteral feeding afger major abdominal injury has been shown to diminish the incidence of major septic complications.On the other hand,there are problems associated with enteral feeding in MOF.This is due sometimes to local damage from peritoneal sepsis but often from deleterious effects of high levels of sympathetic activation on the gastrointestinal tract,combined with some fo the sedative and cardiovascular drugs used to facilitate artificial ventilation or to support the cardiovascular system that also adversely affect gastrointestinal motility.The use of parnteral nutrition in combination with the so-called minimal enteral nutritional support in critically ill patients is mandatory in order to preserve organ function and to avoid deleterious side effects.This strategy of combining the two ways of artificial nutrition is based on the idea to use the gut,if it works,and to complete the full range of essential nutrient supply by the parenteral route.As energy donors,lipid emulsions are an integral element of parenteral nutrition regiments for critically ill patients.Moreover lipids are not only structural building blocks of cells and tissues but at the same time suppliers of C atoms for a number of biosynthetic pathways as well as carriers of essential fatty acids and fat-soluble vitamins.In addition,faty acids are precursors of prostaglandins other eicosanoids and therefore have important metabolic functions.Over the years,for the supply of lipids in the filed of parenteral nutrition,different concepts have been developed.Lipid emulsions derived from soybean or safflower oil contain excessive quantities of PUFA and insufficient amounts of α-tocopherol.Their parenteral use can rapidly lead to an unbalanced pattern of eicosanoids and is associated with an increased production of peroxidative catabolites.In order to avoid negative effects from these metabolic procucts,it is recommended to use preparations with a reduced content of PUFA in combination with an enrichment in α-tocopherol.Indeed the physical mixture of MCT and LCT is a well-proven concept in the parenteral nutrition of critically ill patients.Having a demonstrably higher utilization rate,MCT-containing lipid emulsions do not impair liver function,produce less immune and no RES function compromise,and do not interfere with pulmonary hemodynmics or gas exchange.Newer preparations based on structured triglycenrides or lilve oil appear to achieve the same goal,I.e.reducing the n- PUFA intake.These new lipid emulsions are safe and wel tolerated.Further studies are necessary to investigate potential benefits compared to the physical mixture of MCT/LCT in a clinical environment.A promising substrato in the evolution of parenteral lipid emulsions can be seen in fish oils (n-3 fatty acids).Their fixed combination in a physical mixture of MCT/LCT displays a great number of fascinating aspects.With regard to current literature,n-3 fatty acids have a beneficial influence on the pathophysiological response to dndotoxins and exert important modulations on eicosanoid and cytokine biology.Furthermore their intravenous use may improve organ perfusion in different critical situations.     

腹膜透析抢救急性肾衰伴多脏器功能衰竭的体会

为探讨在急性肾衰伴多脏器功能衰竭中腹膜透析的应用价值，对黑龙江省医院自1999年1月至2003年3月间患急性肾衰伴多脏器功能衰竭行腹膜透析治疗的36例病例进行回顾性分析，现报告如下。     

急性化学物中毒性多脏器功能失常综合征临床分析

目的：探讨急性化学物中毒性多脏器功能失常综合征（MODS）的临床特点。方法：对173例急性重度化学物中毒致多个脏器损害的病例进行分析。 结果：凡能对机体造成重大打击的化学物均可引发MODS,其发病机制主要有两个特点,可为化学物的直接作用或间接作用（继发性损害）,发病类型以原发性多见（占80．76％）,病死率与脏器衰竭的数目,受害程度及急性中毒病因治疗是否及时得当有关。结论：急性化学物中毒性MODS与其它病因所致MODS不尽相同,具有其独特的临床特点。将各脏器功能失常指标分为功能损害和功能衰竭二期可以体现诊断标准的连续动态,功能损害期是早期救治降低MODS病死率的关键时期,在诊断标准中列入相当必要。     

1例多系统脏器功能衰竭抢救成功的护理体会

多系统器官衰竭 (ＭＳＯＦ) ,又称多器官衰竭 ,是指病人因严重感染、创伤、失血、大手术等应激状态下机体出现的两个以上的脏器同时或先后发生的功能衰竭 ,涉及心、肝、脑、肺、肾以及胃肠、代谢、凝血、免疫等各系统功能。据文献报道 ,2个器官受累死亡率为 4 4%～ 6 0 % ,4个以上器官受累死亡率为10 0 % [1] 。我院 2 0 0 0年 12月成功抢救了 1例ＭＳＯＦ ,即 4个脏器受累的病人 ,就此例ＭＳＯＦ病人抢救成功的护理体会作以下介绍。患者女性 ,4 5岁。入院诊断为慢性肾功能不全 ,尿毒症。于 2 0 0 0年 11月 11日行肾移植手术 ,术后第 6天出…     

重急性症胰腺炎合并多脏器损伤34例临床分析

目的探讨急性重症胰腺炎合并多脏器损伤的临床治疗。方法回顾分析34例急性重症胰腺炎合并多脏器损伤患者临床资料,结合文献,就诊疗过程加以总结。结果 34例患者有30例(88.24%)痊愈出院,4例死亡(11.76%)。手术治疗5例,死亡2例;非手术治疗25例,死亡2例;并发症及死亡以多脏器衰竭为主。结论治疗急性重症胰腺炎并发多脏器功能衰竭应采取个体化综合治疗,妥善选择手术时机,能够起到良好治疗效果,提高患者生存率。     

婴幼儿重症肺炎并多脏器功能衰竭52例临床分析

目的分析治疗婴幼儿重症肺炎并多脏器功能衰竭的效果。针对婴幼儿重症肺炎并多脏器功能衰竭,应做到早期诊断,早期治疗,并采取综合措施,有预见性地进行干预治疗。方法 2年来收住婴幼儿重症肺炎314例,并发多脏器功能衰竭52例,经过早期诊断,早期治疗纠正缺氧,保持呼吸道通畅,保护心、脑、肺、胃肠功能、肾功能,尽量不让多个器官受损。结果治愈35例,死亡12例,自动出院5例。其中合并2个系统器官衰竭30例,3个以上系统器官22例,从病史中可以看出多个脏器(3个以上受损,病情越重,病死率越高,达40%;而2个器官以下受损,病死率低,为7.4%。结论对婴幼儿重症肺炎并多脏器功能衰竭,尽量做到超前性干预治疗,可缩短病程,提高治愈率。     

老年重症肺结核并多脏器功能衰竭的临床特征

目的　探讨老年重症肺结核并多脏器功能衰竭的临床特征。方法　分析老年重症肺结核并多脏器功能衰竭的临床表现。结果　老年重症肺结核并多脏器功能衰竭病例男性多于女性、年龄大、病程长、并发症多 ,免疫功能低下容易引起呼吸道感染是诱发多脏器功能衰竭的主要原因。受累脏器数目越多 ,病死率越高 ,病死率为 5 8 9%。 2个受损脏器与 4个受损脏器无显著性差异 ,P >0 0 5 ,2个受损脏器与 5个受损脏器有显著性差异 ,P <0 0 5。结论　掌握老年重症肺结核并多脏器功能衰竭的临床特征 ,重视预防及早期发现 ,治疗中亦密切配合和综合治疗。抗结核治疗中注意肝肾功能 ,并积极预防和治疗呼吸道感染 ,减少诱发因素 ,防止多脏器功能衰竭发生 ,降低病死率。     

急性避蚊胺中毒致多脏器功能衰竭并死亡1例

急性避蚊胺中毒临床罕见。通过回顾性分析收治的1例急性避蚊胺中毒导致多脏器功能衰竭并死亡患者的临床资料,结合文献,探讨急性避蚊胺中毒的救治措施。患者口服大量避蚊胺后,迅速出现昏迷,循环、呼吸等多器官功能衰竭,予以洗胃、血液灌流、血浆置换清除体内毒物,持续静脉-静脉血液滤过稳定内环境及容量管理,抗休克、保护重要脏器等治疗后,患者循环仍难以维持,最终救治效果不佳而死亡。在避蚊胺中毒救治过程中建议多种血液净化方式联合应用,如循环仍难维持,条件允许可尝试体外膜肺氧合治疗,帮助患者度过急性期,避免因循环衰竭加重脏器功能损伤。     

酒精中毒并发多脏器功能衰竭20例报告

酗酒是当今世界范围的一个重要的公共卫生问题。它不仅危害社会治安环境等 ,严重影响了人体健康 ,嗜酒者的死亡率比一般人群要高 1～ 3倍。内科急症病情严重者可出现多个器官功能衰竭 ,其中神经系统疾患、肝脏、心血管病的患病率比一般人群高 2 0 %。本文对 2 0例酒精中毒合并多器官功能衰竭的患者加以报告分析。1　临床资料我们于 1999年 12月至 2 0 0 1年 12月共收治酒精中毒患者160例 ,其中并发多脏器功能衰竭 2 0例 ,男 14例 ,女 6例 ,年龄 2 5～ 60岁 ,饮酒史 6～ 32年不等 ,平均每日饮酒量 80～45 0ml (纯酒精含量 )不等 ,且统计表明…     

产科联合ICU救治孕产妇多脏器功能衰竭38例分析

目的：了解孕产妇多脏器功能衰竭发病的诱因及治疗结局。方法：采用回顾性分析方法对38例妊娠合并多脏器功能衰竭的病例进行分析。结果：38例中死亡5例,病死率为13．16％。其中产科救治18例,死亡4例;产科与ICU共同救治20例,死亡1例。结论：在妊娠合并多脏器功能衰竭的治疗中,产科与ICU联合救治能降低孕产妇的病死率。     

煤工尘肺肺心病并发多脏器功能衰竭36例临床分析

多脏器功能衰竭（MOF）系指肺、心、肾、肝、消化道、凝血系统等生命器官或系统,同时或在短期内先后发生功能衰竭的一种病理状态.肺心病为煤工尘肺的常见并发症,一旦并发多脏器功能衰竭后,其死亡率将明显增加.我院2001年1月～2004年12月共收住肺心病并发脏器功能衰竭患者36例.现报告如下.     

误服氯化汞致多脏器功能衰竭一例报告

该文报道一例患者因误服氯化汞(3.0g),超过致死剂量约2.5倍,由于当时处理措施不当,到上级医院虽经各种急救措施救治,终因汞中毒过重,多脏器功能衰竭而死亡。     

妊娠合并多脏器功能衰竭15例临床分析

目的：探讨妊娠合并脏器功能衰竭MSOF的致病因素,对母婴的影响及防治方法。方法：分析15例妊娠合并MSOF的临床资料。诊断标准,治疗方法。结果：妊娠合并MSOF是一种后果恶劣的妊娠综合征,本文15例中死亡5例,病死率为33．3％,围产儿死率7例（7／16）,死亡率为437．5‰;结论：妊娠合并MSOF是孕产妇和围产儿死亡的主要原因,应加强围产期的系统管理。高危孕产妇应及时转诊,对MSOF的治疗应针对病因,及时去除或减少引起MSOF的诱因,如出血,感染,子病等,阻止过强的应激反应,使MSOF不发生或程度减轻,对妊娠合并征,并发症在产前出现主要脏器功能损害,应果断终止妊娠,减少继续妊娠对母体的损害,对患者应加强监护,注意支持和对症治疗及人工器官如人工呼吸机,血液秀析等的应用。     

老年肺心病合并多脏器功能衰竭危险因素分析

慢性肺源性心脏病(肺心病)是老年人常见病和多发病，由于近年临床诊治水平的不断提高以及患者自我保健意识的加强，使老年肺心病死于单脏器损害者逐年减少，许多患者最后死于多脏器功能衰竭。老年多脏器功能衰竭(MOFE)是指老年人……     

慢性肺心病合并多脏器功能衰竭的临床回顾分析

为探讨慢性肺心病合并多脏器功能衰竭的临床诊治经验,笔者总结了近5年来218例慢性肺心病患者的临床资料,对合并多脏器功能衰竭的97例进行了分析,现将结果报道如下.     

急性脑血管病并多脏器功能衰竭43例临床观察

目的：探讨急性脑血管病（ACVD）并多脏器功能衰竭（MOF）的发病机理及其防治措施。方法：取我院1994年12月－1999年间住院急性脑血管病病人1125例，其中并MOF者43例占3．81％，观察MOF发生率与发病部位，病情轻重，性别及糖尿病，肺感染，高血压，冠心病之间的关系。结果：ACYD患者并发MOF与患者血糖，肺感染病情轻重呈正相关。结论：ACVD并MOF与应激反应，血糖，感染密切相关，对于此病的早期监测至关重要。