儿科加强医疗病房全身炎症反应综合征和多器官功能不全综合征的临床分析 |
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引用本文: | 汤定华,张宇鸣,张国琴.儿科加强医疗病房全身炎症反应综合征和多器官功能不全综合征的临床分析[J].中华儿科杂志,1998(10). |
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作者姓名: | 汤定华 张宇鸣 张国琴 |
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作者单位: | 上海市儿童医院 |
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摘 要: | 目的应用新概念———全身炎症反应综合征(SIRS)和多器官功能不全综合征(MODS)认识多器官功能衰竭(MOF)。方法回顾性总结分析1995年1月~1997年12月我院儿科加强监护病房收治的危重患儿,根据Hayden修订的SIRS诊断标准和全国小儿急诊学组拟定的MOF诊断标准进行临床分析。结果全组304例患儿,符合SIRS标准252例,占82.9%.原发病有感染性疾病和非感染性疾病。在SIRS和MODS病程发展过程中部分患儿出现一过性肝、肾、胃肠道和脑等器官功能受损的表现,最终进展为MODS共65例,占25.8%。MODS的病死率为43.1%(28/65)。发生MODS的高危因素为入院危重评分<75分,明显高代谢反应和合并C反应蛋白,而与年龄无明显关系。结论SIRS和MODS是小儿加强医疗病房中常见病症,病死率较高。SIRS和急诊学组制定的MOF诊断标准简单实用,但应根据美国胸科协会和危重病医学会倡议将MOF更名为MODS。SIRS和MODS进展至器官功能衰竭前存在器官功能受损的表现,应予高度重视并早期干预。
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关 键 词: | 脓毒症综合征 多器官功能衰竭 儿童 加强医疗病房.儿科 |
Clinical analysis of systemic inflammatory response syndrome and multiple organ dysfunction syndrome in PICU |
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Abstract: | Objective To recognize multiple organ failure (MOF) with new concept of systemic inflammatory response syndrome and multiple organ dysfunction syndrome (SIRS/MODS).Methods According to the criteria of SIRS by Hayden and MOF by Chinese Pediatric Emergency Association, 304 cases in PICU were studied from Jan, 1995 to Dec, 1997.Results Two hundred and fifty two cases (82.9%) were diagnosed as SIRS. The underlying diseases were infectious or noninfectious diseases. During the course of SIRS, some patients had organs impairment and 25.8%(65/252) of SIRS patients developed MODS. The mortality rate of MODS was 43.1%. The risk factors of MODS included the score, proposed by a critical scoring system proposed by Chinese Pediatric Emergency Association, below 75, obvious hypermetabolic reaction and CPR.The development of MODS was not related to the age of cases.Conclusion SIRS/MODS is common in PICU and its mortality is high. The diagnostic criteria of SIRS and MOF are simple and practical. But the authors recommend the term of MOF should be changed to MODS. Organs impairment often exists before MODS develops and thus early intervention should be taken in such cases. |
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Keywords: | Sepsis syndrome Intensive core units pediatric Multiple organ failure Child |
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