急性脑血管病的多系统并发症

COMPLICATIONS IN MULTIPLE SYSTEMS RESULTING FROM ACUTE CEREBROVASCULAR DIS-EASES

分析１８５例急性脑血管病的严重并发症，以探讨多脏器系统衰竭（ＭＯＳＦ）的临床特点。结果显示４７例无脏器系统衰竭，４７例为单脏器系统衰竭（ＳＯＳＦ），９１例为ＭＯＳＬ即有１３８例出现单或多个脏器系统衰竭（ＯＳＦ）。５０％病例发生脑疝及合并ＯＳＦ，其中合并单脏器系统衰竭（ＳＯＳＦ）者３９例，ＭＯＳＦ者５３例；有２５％病例死于ＯＳＦ而非脑疝，其中３８例为ＭＯＳＦ，８例为ＳＯＳＦ。好发生衰竭的脏器系统依次为胃＞代谢＞肺＞心＞肾＞血液。梗塞组和出血组的第１个脏器系统发生衰竭的平均时间分别为２４小时和１２．５小时；第２个脏器系统平均时间分别为４天和２４小时。ＯＳＦ的发生与性别、原患病及脑干受损有关，但与病灶大小、数量及血肿破入脑室无关。因此，脑原性多脏器系统衰竭存在独特的临床特点及发病机制。

ne hundred and eighty five patients died of acute cerebrovascular diseases with complications in mul-tiple systems were studied. Statistical analyses showed that there were no organ and system failure(NOSF)in 47 cases, single organ and system failure (SOSF)in 47 and multiple organ and system failure(MOSF)in 91.Out of 90 (50%)cases who had cerebral herniation, 39 cases were complicated with SOSF and 53 cases with MOSF. Among the patients with acute brain diseases,25%of them(46)died of SOSP(4%, 8 cases)and MOSF(21%, 38) without herniation. Incidence of failure of organ and system was higher with stomach,metabolism and lung than with heart,kidney and blood,It took on the average 24 and 12. 5 hours for the first organ and system to fail and 4 days and 24 hours for the second organ in pa-tients with intracranial hemorrhage and cerebral infarction. Occurrence of organ and system failure was closely related to sex,previous diseases and damage of brain stem,but not to the size and number of the le-sion. It is suggested that cerebrogenic organ and system failure(COSF) or cerebrogenic multiple organ and system failure(CMOSF)be referred to functional failure of more than two organs or system not including brain itself as a result of acute brain diseases.