外科重症病监护中心抢救64例术后合并ARDS/MODS的回顾性研究

Retrospective study on the emergency treatment of 64 patients with postoperative ARDS/MODS in surgical ICU

目的：回顾性分析过去10年抢救ARDS／MODS的疗效，探讨诊断治疗中的经验。方法：将1996—06～2006—12收入ICU中心的624例危重急症病例按统一标准筛选出符合ARDS／MODS64例，根据ICU专业建设不同年份分为1996—06～2000—12（A组n=21）、2001—01～2004—06（B组n=22）、2004—07～2006—12（C组n=21），3组均按高海拔地区ARDS／lMODS评分系统相关指标参数进行统计，比较3组人住ICU的APACHEH、MODS、SSS评分、住ICU时间、带机时间和结局。结果：住ICU时间、带机时间C组明显短于A组，P〈0．05；病死率明显低于A组和B组，P〈0．05。3个不同时期MODS多脏器指标参数、APACHEII总分、MODS总分评估差异不明显，P〉0、05。结论：由普通病房转入ICU时间、上机时间、上机适应证的掌握和诊断救治技术等因素是影响治疗结局的主要原因。

Objective ：To retrospectively analyze the curative effect of the patients with ARDS/MODS in past ten years, and summarize the experience. Methods： 64 were chosen from 624 cases of severe trauma hospitalized in the surgical ICU from June, 1996 to Dec, 2006, according to the diagnosis standard of ARDS/MODS. They were divided into three groups basing on different time： group A （ 1996 -2000, n =21 ） ; group B （2001 -01 -2004 - 06, n =22） and group C （2004-07 -2006- 12, n =21 ）. The multi- organ dysfunctional indices and their parameters were collected and calculated simultaneously by the same scoring criterion at high altitude. Results： There was no significant difference in the baseline material of three groups （ P 〉 0.05 ）. The interval time from general ward to intensive care unite were longer in group A and B than in group C （ P 〈 0.05 ）. The time for ventilator support was obviously earlier in group C than in groups A and B, and the mortality rate of MOBS decreased significandy （ P 〈 0.05 ）. Conclusion： The mastering of multi - organ function monitoring and multi - organ dysfunction scoring as well as the early use of mechanical ventilator support are the key factors determining the therapeutic effect of the patients with MOBS.