老年多器官功能不全综合征临床特点分析

Clinical features of multiple organ dysfunction syndrome in the elderly:analysis of 545cases

目的分析老年多器官功能障碍综合征(MODS)的患病特点。方法采用前瞻性的研究方法,收集2002年3月至2005年1月北京、天津、山东、河北、河南等地七所三级甲等医院545例MODS患者(老年373例,非老年172例)的临床资料,比较分析老年和非老年MODS患者的患病特点。结果老年组MODS患者的病死率、既往有慢性基础病的比例均显著高于非老年组(65.1%vs 47.1%,81.5%vs 41.9%,均P<0.001)。老年组住ICU时间显著高于非老年组。老年组5个以上器官/系统功能障碍的发生率显著高于非老年组(78.6%vs 70.3%,P=0.037)。老年组脑功能障碍的发生率明显高于非老年组(75.1%vs 62.8%,P=0.003)。老年组发生肺、胃肠、脑、心、肝、肾、凝血系统功能障碍的病死率均显著高于非老年组。结论老年MODS患者病程迁延,病情重,病死率高,多合并慢性基础病,脑功能障碍的发生率高。

Objective To analyze the clinical features of multiple organ dysfunction syndrome in the elderly （MODSE）. Methods Clinical data of 545 cases of MODSE were collected and studied prospectively in 7 tertiary-level teaching hospitals of Beijing and Tianjin cities and Shandong, Hebei and Henan provinces from March 2002 to January 2005. They were divided into 2 groups： elderly group （172 cases） and non-elderly group （373 cases）, and their clinical data were compared and analyzed. Results The mortality in elderly group was obviously higher than that in non-elderly group （65.1% vs 47.1%, P〈0. 001）. Of the elderly patients, 81.5% had a history of chronic diseases, which was higher than that of non-elderly patients（41.9%, P〈0. 001）. The proportion of patients with more than 5 organs/systems dysfunction was higher in elderly group than in non elderly group （78.6% vs 70.3%, P=0. 037）. The incidence of brain dysfunction was higher in elderly group than in non-elderly group （75.1% vs 62.8%, P= 0. 003）. Besides, the fatality rate due to lung, brain, cardiovascular system, liver, kidney, gastrointestinal system and coagulation system dysfunction was higher in elderly group than in non-elderly group. Conclusion The elderly with MODS has long course of disease, serious clinical manifestations, high fatality rate and high incidence of brain dysfunction and most patients have chronic diseases.