CAJ | 학술논문

目的分析"5·12"四川汶川特大地震重症伤员多器官功能障碍综合征(MODS)的特征与处理结果,为今后的早期诊断与治疗提供理论依据.方法 2008年5月12日-6月20日华西医院共收治地震伤员2 708例,其中重伤员1 153例,收入重症监护病房(ICU)142例,42例发生MODS,分析其基本情况、病情特征、生存者与死亡者重要指标差异、治疗措施及治疗时间.结果 MODS患者入院时急性生理学与慢性健康状况评分系统II(APACHE II)评分及预测死亡风险均随治疗进展逐步下降;地震伤疾病构成中肢体骨折最多见,发生率为45.2%;42例MODS患者中死亡14例,总体病死率9.8%,实际病死率为33.3%,低于预测死亡风险(41.5%).生存组与死亡组间年龄、伤后首次接受ICU救治的时间、格拉斯哥昏迷评分(GCS)、氧合指数、肌酐、血小板计数、血管活性药物泵速等指标差异均有统计学意义(P均＜0.01);伤情构成中,心功能不全、急性肾功能衰竭及脓毒症差异有统计学意义(P均＜0.05).42例MODS患者接受呼吸机支持治疗、连续性肾脏替代治疗(CRRT)、血管活性药物的使用率在地震发生后14～29 d达到高峰.结论本次地震伤MODS患者以肢体骨折最为多见,死亡原因与多发创伤及巨大创面所诱发的急性肾功能不全、全身性感染等密切相关;在治疗过程中应加强对中枢系统、呼吸系统、循环系统、肾功能以及血液系统的监测及治疗.在自然灾害发生后的初期应做好充分的医疗准备以应对高峰阶段大规模的伤员救治.
목적 분석"5·12"사천문천특대지진중증상원다기관공능장애종합정(MODS)적특정여처리결과,위금후적조기진단여치료제공이론의거.방법 2008년5월12일-6월20일화서의원공수치지진상원2 708례,기중중상원1 153례,수입중증감호병방(ICU)142례,42례발생MODS,분석기기본정황、병정특정、생존자여사망자중요지표차이、치료조시급치료시간.결과 MODS환자입원시급성생이학여만성건강상황평분계통II(APACHE II)평분급예측사망풍험균수치료진전축보하강;지진상질병구성중지체골절최다견,발생솔위45.2%;42례MODS환자중사망14례,총체병사솔9.8%,실제병사솔위33.3%,저우예측사망풍험(41.5%).생존조여사망조간년령、상후수차접수ICU구치적시간、격랍사가혼미평분(GCS)、양합지수、기항、혈소판계수、혈관활성약물빙속등지표차이균유통계학의의(P균＜0.01);상정구성중,심공능불전、급성신공능쇠갈급농독증차이유통계학의의(P균＜0.05).42례MODS환자접수호흡궤지지치료、련속성신장체대치료(CRRT)、혈관활성약물적사용솔재지진발생후14～29 d체도고봉.결론 본차지진상MODS환자이지체골절최위다견,사망원인여다발창상급거대창면소유발적급성신공능불전、전신성감염등밀절상관;재치료과정중응가강대중추계통、호흡계통、순배계통、신공능이급혈액계통적감측급치료.재자연재해발생후적초기응주호충분적의료준비이응대고봉계단대규모적상원구치.
Objective To analyze the characteristics and treatment of the mutiple organ dysfunction syndrome(MODS)in patients in the Wenchuan earthquake on 12th May,2008,in order to provide theoretical reference for future care for such patients.Methods Characteristics of MODS in these patients were analyzed,differences between survivors and non-survivors were compared,and therapeutic measures,and the time of the treatment for MODS in patients with earthquake related injury or illness who were admitted to West China Hospital from 1 2th May to 20th June,2008,were retrospectively analyzed.Results A total of 42 MODS patients were admitted to intensive care unit(ICU).Both the acute physiology and chronic health evaluation II(APACHE II)score and predicted death risk were lowering during the course of therapy.Fractures of bones of extremities were predominant in the earthquake related diseases,with an incidence of 45.2%.The actual mortality of MODS(33.3%)was lower than the predicted death risk (41.5%).The age,the time of receiving the first treatment in ICU after the earthquake,the Glasgow score,the oxygen index,blood creatinine lever,platelet count,and vasoactive agent pumping velocity were significantly different between survivors and non-survivors(all P<0.05).The overall mortality was 9.8%,the morbidity of cardiac dysfunction.the incidence of acute renal failure(ARF)and sepsis were significantly different between non-survivors and survivors(all P<0.05).The use of mechanical ventilation,continuous renal replacement therapy(CRRT),and vasoactive agent reached peak level on the 14-29 days after the earthquake.Conclusion Fracture of bones of extremities are predominant injury in the earthquake related diseases,and the cause of death is closely associated with multiple trauma and ARF,systemic infection of large wound surfaces.The central nervous system,respiratory system,circulatory system,renal function,circulatory system should be monitored during the treatment.Adequate preparedness is essential in order to cope with the peak period of occurrence of serious complications after a disaster.