急性中毒伴多器官功能障碍综合征的临床分析

Clinical Analysis of Acute Poisoning Accompanied with Multiple Organ Dysfunction Syndrome

目的:调查急性中毒伴多器官功能障碍综合征(MODS)的发病情况、临床特征和转归。方法:回顾性分析355例急性中毒患者,其中76例伴MODS。结果:76例伴MODS中,死亡17例,病死率22.4％。发生2、3、4、5或5个以上器官功能障碍者病死率分别为3.7％、12.0％、44.4％、83.3％。受累器官个数在死亡组和存活组的比较差异显著(X^2=99.81,P<0.005)。器官功能障碍发生率:脑(97.4％)、呼吸(94.7％)、循环(92.1％)、肝脏(55.3％)、肾脏(52.6％)、胃肠道(42.1％)、血液(31.6％)。各器官衰竭的构成比:呼衰47.1％、心衰29.4％、脑衰17.6％、肾衰5.9％。结论:不同中毒致MODS的病死率不同,且随器官障碍数目的增加而升高;不同中毒致MODS其器官障碍顺序不同,直接死亡原因也不同,这有助于临床医生早期诊断和干预可能发生的器官功能障碍,降低病死率。

Objective: To investigate the pathogenic process, clinical characteristics and outcome of acute poisoning accompanied with multiple organ dysfunction syndrome (MODS). Methods: 76 cases accompanied with MODS from 355 patients of acute poisoning were analyzed retrospectively. Results: 76 cases with MODS were observed, 17 cases died, the total mortality was 22.4%. The mortality with two, three, four and five or more than five organs dysfunction were 3.7%, 12.0%, 44.4% and 83.3% respectively. The numbers of involved organs were very different between the died group and the survival group(x^2=99.81, P<0.005). The occurrence rate of each organ dysfunction descended in the order of Brain (97.4%), Lung(94.7%), Circulation(92.1%), Liver(55.3%), Kidney(52.6%), Digestive tract(42.1%) and Blood (31.6%). The ratio of organs failure was respectively: Respiration(47.1%), Circulation(29.4%), Brain (17.6%), Kidney(5.9%). Conclusion: Different kinds of acute poisoning with MODS caused different mortality that increased with the number of involved organs and resulted in different organs dysfunction and direct death causes. These make doctors diagnose and interfere MODS early, and decrease the mortality.