老年多器官功能不全综合征274例危险因素的分析

目的通过对老年多器官功能不全综合征（MODSE）的各项资料进行统计分析，寻找出本综合征发病的重要危险因素，进一步为临床防治MODSE奠定基础。方法对2003年10月至2006年10月昆明市中医医院274例MODSE患者的临床资料进行相关因素回顾性分析。结果诱发因素中以肺部感染占首位（35．77％）；总衰器官、首衰器官发生频率亦以肺居于首位（74．09％、38．32％）；胃肠道在总衰器官发生频率中居第二位（73．72％）；外周循环功能不全或以休克诱发MODSE患者的病死率、0R值、病情严重程度评分均明显高于其他；累积衰竭器官的数目与死亡危险度呈正相关；MODSE衰竭期死亡率明显高于衰竭早期。结论老年人肺部感染为MODSE主要诱发因素，此与文献报道相一致。临床在使用抗生素的基础上，积极加强雾化及排痰护理，配合使用清热化痰的中药汤药或制剂，“菌、毒、炎”并治，对切断MODSE的发展具有积极作用；MODSE病程中胃肠功能不全普遍存在，故临床注重调整胃肠功能应是干预救治MODSE的关键环节；外周循环功能不全是导致MODSE高死亡率的主要原因，纠正外周循环功能不全对阻止MODSE的进行性恶化具有重要的作用。

Risk factors of the multiple organ dysfunction syndrome in the elderly: analysis of 274 cases

Objective To find risk factors for multiple organ dysfunction syndrome （MODSE） and to lay foundation for clinical prevention and therapy measures. Methods From 2003 to 2006, 274 MODSE cases were enrolled in a retrospective study of correlative risk factors for MODSE in Kunming Traditional Chinese Medicine Hospital. Resuits Pulmonary infection was still the primary inducing factor for MODSE （35.77%）. Lung also ranked first in both first dysfunction organs and total dysfunction organs （74.09%, 38. 32% respectively）. Gastrointestinal dys-function ranked second in total dysfunction organs（73.72%）. The fatality rate, odds ratio value and APACHE 11 score were significantly higher in shock or peripheral circulation dysfunction than in others . There was positive correlation between the total number of prostrated organs and mortality risk, and the mortality rate was higher in prostrate phase than in pre-prostrate phase. Conclusion Pulmonary infection was the main inducing factor of MODSE, which accord with literature reports. Atomization and clearing of phlegm should be intensified in addition to routine antibiotics. At the same time, Chinese herbs for eliminating heat and removing phlegm can be used in order to reduce bacteria, toxin and inflammation. Gastrointestinal dysfunction occurs frequently in MODSE, so regulating gastroin testinal function is the key step in MODSE therapy. Peripheral circulation dysfunction was the main cause leading to high mortality rate in MODSE, it is very important to rectify the peripheral circulation function for MODSE patients, which can prevent the deterioration of MODSE.