多器官功能障碍综合征诊断标准、病情严重度评分及预后评估系统和中西医结合证型诊断

Diagnosis criteria, severity scoring system, and the prognosis evaluation system of integrated Chinese traditional and western medicine for multiple organ dysfunction syndrome

目的建立符合循证医学的多器官功能障碍综合征（MODS）诊断标准、病情严重度评分系统和中西医结合证型诊断。方法本课题组遵循循证医学理论，通过前瞻性、多中心、大样本研究，收集2002年3月-2005年1月全国11个省市、36家三级医院重症加强治疗病房（ICU）内总计1087例MODS病例的临床资料。其中728例用于建立MODS诊断标准草案模型，建立MODS病情严重评分模型，建立MODS死亡概率预测样本模型；362例用于验证MODS诊断标准，验证MODS病情严重度评分模型，验证MODS死亡概率预测方程。经过统计分析，并结合专家讨论意见，制定MODS诊断标准、病情严重度评分、预后评估系统和中西医结合证型诊断方案。结果MODS诊断标准、病情严重度评分、预后评估系统包括7个器官、系统以及判断脏器功能的指标，可以对MODS进行诊断和病情严重度评价；MODS中西医结合证型诊断总结了热证、血瘀证、腹气不通证和厥脱证4种主要的证型。结论本诊断标准只是初步的草案，可以临床应用，但是还有待进一步完善，以期达成共识。

Objective To establish diagnosis criteria and severity scoring system for multiple organ dysfunction syndrome （MODS） with integrated Chinese traditional and western medicine for MODS according to the principles of evidence-based medicine. Methods Our research group had conducted a prospective and multiple-center study, collecting the clinical data of 1 087 MODS patients admitted to 36 intensive care units （ICUs） of hospitals in 11 provinces in China from March 2002 to January 2005. After statistical analysis and a consensus discussion of specialists, the diagnosis criteria, severity scoring system, and a fatality prediction model were established for MODS. Results The diagnosis criteria and severity scoring system included seven organs and related indexes for the diagnosis of MODS. The criteria based on integrated traditional and western medicine consisted four distinct symptom complexes. Conclusion The diagnostic criteria are only a preliminary draft to be used and evaluated in clinical setting, and it should be revised to reach a consensus of opinion.