心内直视手术后多脏器功能衰竭的危险因素与防治措施

目的　探讨心脏直视手术后多脏器功能衰竭 (MSOF)的危险因素和防治措施。方法　回顾分析 33例心脏直视手术后MSOF的临床资料 ,并就基础心脏病变、术前心肺功能状况、体外循环时间等与MSOF的发生率和病死率进行统计分析。结果　本组MSOF发生率为 0 73% (33/ 4 5 5 0 ) ,总计发生衰竭脏器 91个 ,平均 2 76个 ;总的病死率为 5 4 5 % (18/ 33) ,2个衰竭脏器的病死率为 36 8% (7/ 19) ,3个衰竭脏器的病死率为 6 2 5 % (5 / 8) ,4个衰竭脏器的病死率为 10 0 % (6 / 6 )。结论　基础心脏病变重、术前心肺功能差、体外循环时间过长是MSOF发生的高危因素 ,病死率与衰竭脏器数有关 ,数目越多病死率越高 ,重在预防。

Research into treatment and prevention of multiple system organ failure after open- heart operation

Objective To survey the risk factors of multiple system organ failure (MSOF) after open-heart operation,and analyse the measures of treatment and prevention for MSOF.Methods The clinical data were retrospectively studied in 33 cases with MSOF after intracardiac operation.The relationship between MSOF and the primary heart diseases,condition of heart function and lung function,duration of on-pump and clamped aorta were analysed statistically.Results The morbidity was 0.73%(33/4 550).Total organs failure occurred in 91,and the mean was 2.76 in each patient.The total mortality was 54.5%(18/33),and 36.8%(7/19)in the patients with two organs failure,62.5%(5/8)with three and 100% (6/6) with four or more.The others recovered well.Conclusion Severely primary heart diseases,bad dysfunction of preoperative heart and lung,and the long duration of on-pump were the risk factors of MSOF after intracardiac operation.The mortality were related to the amounts of organ failure,and the more the quantity was,the higher the mortality was.The key to treatment was prevention.