危重患儿多器官功能障碍综合征部分血液生化指标探讨

Change of blood biochemical parameters in critical children with multiple organ dysfunction syndrome

目的探讨危重患儿在多器官功能障碍综合征（MODS）时的血液化学变化，加强对MODS及多器官衰竭（MOF）的临床早期预警。方法对确诊为危重病例的患儿24、48、72h进行血液化学及生命体征变化进行分析，对危重患儿进行危重病例评分及器官功能障碍评价。结果在危重患儿发病24、48、72h内进行连续监测，其血液化学变化在48-72h内诸多指标明显增高，且与MODS的发生呈同步性变化（r=0．75）。在疾病早期，肝肾功能、心肌酶、血糖及乳酸等指标已经发生改变。表明机体相关的脏器功能已经受到了不同程度的影响；缺氧程度越重，乳酸增高越明显。结论危重患儿器官衰竭症状尚未表现或症状极轻微，而血液化学已出现衰竭的表现。同时，小儿危重病例评分及器官功能障碍数目关系密切。高度重视对MODS的临床血液化学主要指标的检测，有助于MODS的早期诊断及治疗。

Objective To explore the role of blood biochemical parameters in the critical children with multiple organ dysfunction syndrome （ MODS ） so as to enforce the clinical prewaming management in MODS and multiple organ failure （ MOF）. Method Blood biochemical chemistry and life signs of the critical children were collected at 24,48,72 hours after admission to PICU. The pediatric critical illness score and organ dysfunction score were carried out simultaneously. Result Continuous monitoring were performed in 48 children with severe disease at 24,48,72 hours, the obvious increase of blood biochemical parameters were found at 48 - 72 hours, which accompanied with the development of MODS （ r = O. 75）. In earlier period of severe disease, liver and renal function, myocardium enzyme, blood glucose and lactic acid had changed obviously, which indicated that some of organs had been injured at different degrees. The worse the oxygen deficiency was, the more increased the lactic acid was. Conclusion Blood biochemical parameters had appeared to be failure before the symptom of organ failure in severe patients developed or occurred slightly. A close relationship between the pediatric critical illness score and the dysfunction of organ were found in our study. The detection of blood biochemical parameters in critical children with MODS plays an important role in early diagnosis and treatment of MODS.