多脏器功能障碍综合征分型与全身炎症反应综合征临床分析

调查儿科危重症病房(PICU)原发性和继发性多脏器功能障碍综合征(MODS)发病率和两类MODS的临床特点,并探讨临床治疗对策。对2000年1月到2001年12月期间收入PICU患儿进行回顾性调查。以队列研究方法对MODS的发病率进行分类统计和危险因素分析。结果:2年共收治患儿941例,年龄中位数为12个月(1月～180月),<1岁485例(51.5％)。有先天性或慢性疾病史319例(33.9％),恶性病史41例(4.4％)。MODS累积发病率为16.9％(159/941例),发病密度为16.2/1000病人天。原发性MODS 108例(67.9％),继发性51例(32.1％)。原发性MODS好发于<1岁婴儿,急性起病。原发感染性疾病、气道梗阻、重度脱水或心跳呼吸骤停为常见危险因素。继发性MODS多存在慢性疾病状态和恶性病,以全身炎症反应综合征(SIRS)、脓毒血症(sepsis)、难治性休克为主要表现。原发性和继发性MODS病死率分别为50.9％和74.5％。提示PICU的MODS累积发生率为16.9％,原发性和继发性MODS发生率和病死率不同。对不同类型的MODS宜采用相应的治疗策略。

Clinical analysis on the relationship between the classification of the multi-organ dysfunction syndrome and systemic inflammatory response syndrome

To investigate the morbidity of the primary and secondary multi-organ dysfunction syndrome (MODS) as well as the clinical characteristics and the therapeutic strategy of these two types of MODS in the P1CU of our hospital, all the patients data admitted to our PICU were reviewed retrospectively from Jan. 2000 to Dec. 2001. MODS morbidity was analyzed with cohort statistics presented by cumulated incidence and density of incidence also accompanied with risk factor analysis. 941 cases with critical condition were enrolled in two years. The median age was 12 months(ranged from one month to 180 months) .The age of 485 cases(51.5%) was less than 12 months. 319 cases (33.9%) had congenital and chronic disease history. 41 cases (4.4%) had malignant history. The MODS cumulated morbidity accounted for 16.9% (159/ 941 cases) .The density of incidence was equal to 16.27 1000 per patient/day, including 108 cases with primary MODS and 51 cases with the secondary MODS.The risk factors for primary MODS were as following: infants, acute, primary infective disease, and airway obstruction. Severe dehydration or sudden cardiopulmonary arrest, while the risk factors for the secondary MODS listed below was severe chronic disease and malignancies with systemic inflammatory response syndrome (SIRS),sepsis and refractory shock as the main presentation.The mortality for primary and secondary MODS accounted for 50.9% and 74.5% respectively.The cumulative incidence of MODS in 2 years was 16.9% with the ratio between these 2 types of MODS 2 : 1 . The morbidity and mortality for primary and secondary MODS were both different in PICU.Thus, relevant therapeutic strategy should be taken in dealing with the different type of MODS accordingly.