产科危重患者多器官功能障碍综合征的临床分析

目的 :分析产科危重患者多器官功能障碍综合征 (MODS)的发病特点及诱因 ,以及与急性生理与慢性健康状况评分II(APACHEII)的关系。方法 :回顾分析 2 0 0 0年1月至 2 0 0 4年 4月转入GICU产科危重患者中发生MODS 6 6例的临床资料 ,并计算其A PACHEII评分。结果 :产科MODS患者诱因主要是产科因素 ,共 4 8例 (72 .73% ) ,死亡 7例 (14 .5 8% ) ,以重度子痫前期或子痫及产后出血为主 ;诱因 18例妊娠合并内外科疾病 ,死亡 11例 ,死亡率为 6 1.11% ,以妊娠合并心脏病和妊娠合并重症肝炎为主。产科MODS患者死亡率随着器官损害数的增多而上升 ,差异有显著性 (P <0 .0 5 ) ;随着器官损害数的增多 ,APACHEII评分逐渐升高 ,差异有显著性 (P <0 .0 5 ) ;APACHEII评分用于预测MODS死亡阳性率 ,2 ,3,4 ,5个器官受损害 ,其阳性率分别为 33.4 5 % ,5 7.12 % ,97.0 9% ,10 0 %。结论 :产科多器官功能障碍 /衰竭的产科主要诱因是重度子痫前期 /子痫 ,产后出血 ;产科MODS患者死亡率也随着器官损害数的增多而上升 ;APACHEII评分可在一定程度上作为评定产科MODS患者病情危重程度和预测预后的指标。

Clinical analysis of critically ill obstetric patients with multiple organ dysfunction syndrome

Objective:To analyse the clinical features of criticall y ill obs tetric patients with multiple organ dysfunction syndrome(MODS) and to describe t he outcomes predictability of these cases using the acute physiology and chroni c health evaluation II (APACHE II) scoring system.Method:The clin ial data of critically ill obstetric patients with MODS (n=66) admi tted to general intensive care unit from Jan 2000 to Apr 2004 was reviewed an d APACHE II scores were calculated.Results:There were 48 cases with o bstetric reasons for MODS in critically il l obstetric patients , 7 deaths (14.58%), the most common obstetric reasons were severe preeclampsia/eclampsia and postpartum hemorrhage; there were other 18 ca ses with preexisting medical conditions and 11 deaths (61.11%), the common medic al reasons were preexisting cardiac diseases and severe hepatitis . The m ortalit y significantly increased along with the increase in number of organs/systems dy sfunction in the MODS patients(P<0.05); the APACHE II scores also s ignificantly increased along with the increase in number of organs/systems dysfunction in the MODS patients(P<0.05);predicted mortality in APACHE II for t he MODS patients with 2,3,4,5 organs/systems dysfunction were 33.45%,57.12%,97.09%,100%, respec tively.Conclusion:The most common obstetric reasons for MODS in critically ill obstetric patients are severe preeclampsia/eclampsia and postp artum hemorrhage ; the mortality also increased along with the increase in number of organs/syste ms dysfunction in the obstetric patients with MODS; to some extent, APACHE II ca n be used to predict the prognosis of critically ill obstetric patients with MOD S.