感染性多脏器功能不全综合征中西医结合诊治的研究

目的：探讨感染性多脏器功能不全综合征（MODS）／多脏衰（MSOF）的中西医结合诊治方法，以提高本症抢救成功率。方法：对急性感染并发MODS／MSOF住院患者225例，进行原发疾病、并发症等的西医诊断和证型的中医辩证诊断，据此在全面西医西药治疗的基础上，应用中药以中西医结合方法治疗，并进行临床观察和中药治疗作用的机理研究。结果：止于1998年底共救治感染性MODS患者225例，抢救成功161例，死亡64例，病死率28.4％；其中MSOF140例，死亡58例，病死率为41.4％，应用美国KnausWA教授MSOF诊断标准，本组符合者106例，抢救成功52例，死亡54例，死病率为50.9％。结论：应用中西医结合方法 治疗本综衙，疗效显著提高， 在于中药可改善患者的血流动力学、血液流变学、甲襞微循环障碍；影响细胞因子、炎症介质水平，从而减轻全身性炎症反应，并可减轻胃肠运动功能的受抑制状态、肠道菌群失调及防治肠道细菌、内毒素移位；抗氧化保护细胞作用。

Study on Di

Objective: To explore the diagnostic and therapeutic approach of integrated traditional Chinese and western medicine (TCM WM) on infectious multiple organ dysfunction syndrome/multiple system and organ failure (MODS/MSOF) for elevating the successful rate of rescuing the patients. Methods: Diagnosis with western medicine and Syndrome Differentiation of TCM in 225 in patients of acute infectious disease complicated with MODS/MSOF were conducted, and TCM treatment, based on western medical comprehensive treatment, was given to observe the effect and explore the mechanism of the TCM WM therapy. Results: Up to the end of 1998, 161 cases of the 225 cases were successfully cured and 64 died, the mortality being 28.4%. Among them, 58 out of 140 cases of MSOF died, the mortality was accounted for 41.4%. In 106 cases conformed to the diagnostic criteria of MSOF proposed by Professor Knaus WA, USA, 52 cases were cured successfully and 54 died, the mortality being 50.9%. Conclusion: TCM WM treatment could elevate the therapeutic effect in treating MODS, the mechanism might be through improving the hemodynamic and hemorrheologic condition of patients to relieve nail fold microcirculation disorder; influencing the levels of cytokine and inflammatory mediator, so as to alleviate the systemic inflammatory reaction, it might also abate the inhibited condition of gastro intestinal motility, alleviate the intestinal flora imbalance, prevent intestinal bacteria and endotoxin malposition, and protect cells from peroxidation.