急性重症胆管炎死亡的高危因素和对策分析

目的：探讨急性重症胆管炎死亡的高危因素和对策。方法：分析93例急性重症胆管炎的资料，其中60岁以下49例，60岁以上44例，Charcot三联征78例，Reynold五联征13例，确诊6h内手术46例，6h后40例，治疗期间多器官功能不全18例。结果：痊愈72例，死亡21例，死亡率22．6％(21／93)；60岁以下和以上组死亡率分别为10．2％、36．3％；确诊6h内和6h后手术组死亡率分别为13．O％、37．5％；Charcot三联症和五联症死亡率分别为19．2％、46．1％。结论：高龄、延误手术时机、合并MODS是死亡的高危因素，早期手术、警惕继发性胆道结石、强化术后ICU监护是降低死亡率的有效方法。

The Analyses of High Risk Factors of Death and Countermeasure for Acute Cholangitis Severe Type

Objective To explore both high risk factors of death and countermeasure for acute cholangitis of severe type (ACST).Methods Analysis datum of 93 cases of ACST,among these,49 cases were below 60 years old,44 over 60 years old,78 cases present charcot triad sign,13 cases reynold penta sign,18 cases had multiple organ dysfunction sydrome during therapy stage.Results Seventy two cases recovered and 21 cases died with death rate of 22.6%(21/93);Death rates of below 60 year old and over 60 year old were 10.2% and 36.3%,respectively;In operation groups the rates were 13.0% if final diagnosis was made in 6 h and 37.5% if made after 6 h.Death rate of charcot triad sign and penta sign were 19.2% and 46.1%.Conclusion Advanced age?delaying operation time and MODS are high risk factors leading to death in ACST.Early operation?precaution of secondary calculus of bile duct and reinforcing surgical ICU monitoring are effective methods to lower mortality rate.