老年多器官功能障碍综合征的死亡因素分析

Cause of the death of multiple organ dysfunction syndrome in the elderly

目的分析老年多器官功能障碍综合征(MODSE)的原发病因、病死率及死亡危险因素。方法多中心、前瞻性分析462例MODSE患者的临床资料。结果MODSE原发病因是重症感染、休克、大手术后、心肺复苏后、严重创伤、重症胰腺炎等。462例MODSE患者病死率为65.8%,发生5～7个器官功能障碍者居多(占77.1%)。病死率随受累器官数目的增加而增高;器官功能障碍的发生率依次为肺、胃肠、肝脏、肾脏、凝血系统、脑、心脏,其中脑功能障碍的病死率最高。死亡组年龄、器官障碍数、APACHEⅡ评分、PaCO_2及慢性阻塞性肺疾病、慢性心功能不全的发生率均高于存活组,而收缩压、舒张压、平均动脉压、PaO_2、氧合指数、Glasgow评分均低于存活组。通过Logistic回归分析,年龄(P<0.01)、平均动脉压(P<0.01)、氧合指数(P<0.05)、Glascow评分(P<0.001)是MODSE死亡的危险因素。结论MODSE受累器官多,重要脏器存在慢性基础疾病,病死率较高,年龄和心功能、肺功能、脑功能障碍是MODSE死亡的危险因素。

Objective To analyze the primary etiological factor, mortality, and risk factors of death of multiple organ dysfunction syndrome in the elderly （ MODSE）. Methods To analyze prospectively the clinical data of 462 patients with MODSE. Results The primary etiological factor of MODSE included severe infection, shock, major post - operation, post - CPR, severe trauma, and severe pancreatiffs. Mortality of 462 MODSE patients was 65.8%, and most patients had the dysfunction of 5 -7 organs （77.1%）. In this research, the mortality rate of MODSE increased with the increase of affected organs numbers. The lung easily suffered from organ dysfunction, other organs were stomach and intestine, liver, kidney, blood, brain and heart in order, and the mortality rate of patients with brain dysfunction was the highest. Compared with survival group1 age, the number of organs dysfunction, APACHE Ⅱ score, oxygenation index, PaCO2, the incidence rate of chronic obstructive pulmonary disease （COPD） and chronic cardiac insufficiency were higher in death group, and systolic pressure, diastolic pressure, mean arterial pressure, PaO2, oxygenation index and Glascow score were lower. Age （ P 〈 0.01 ） , mean arterial pressure（ P 〈0. 01）, oxygenation index（ P 〈0. 05）, Glaseow score were risk factors of the death of MODSE by Logistic regression analysis. Conclusions MODSE affected many organs, caused chronic basic diseases in important organs, and had a higher mortality rate. Risk factors of death included age, the dysfunction of heart, lung and brain.