摘要
目的探讨肾移植术后并发多脏器功能障碍综合征（MODS）的发生率、发生的高危因素,导致死亡的高危因素以及临床评价方法。方法总结48例肾移植术后出现MODS患者的临床资料,将肾移植术后发生与未发生MODS的患者进行对比,比较肾移植术后并发MODS的发生率、高危因素等;将肾移植术后并发MODS中死亡与未死亡患者进行比较,回顾性分析其死亡率、导致死亡的高危因素及临床评价方法。结果肾移植术后并发MODS患者的年龄显著大于未并发MODS患者,前者的急性排斥反应发生率明显高于后者,前者使用激素冲击、抗胸腺细胞球蛋白（ATG）或CD3-单克隆抗体（OKT3）的比例明显高于后者;肾移植术后并发MODS死亡患者的年龄显著大于未并发MODS患者、前者的急性排斥发生率明显高于后者;脏器衰竭数目分别为2、3、4个时,患者的病死率分别为40%、75%、100%;MODS评分分别为0~4、5~7、8﹥分时,患者的病死率分别为40%、57.1%、100%。结论肾移植术后发生MODS的高危因素为高龄、曾经发生过急性排斥反应、曾经使用过激素冲击、ATG、OKT3治疗等;影响MODS患者死亡的高危因素为MODS评分、衰竭脏器数目、高龄、曾经发生过急性排斥反应、曾经使用过激素冲击、ATG、OKT3治疗等,容易导致肾移植术后患者发生MODS的首发因素依次为肺部感染、移植肾功能延迟恢复、消化系统出血。
The patients with MODS were compared with those without MODS, and the incidence and high risk factors were retrospectirely analyzed. The dead and alive patients of MODS were compared and the mortality, high risk factors for death and clinical evaluate method were retrospectively analyzed. Results Compared with patients without MODS after renal trausplantation, patients of MODS were older, and had higher incidence of acute refection and higher percentage of using steroid pulse, ATG of OKT3; Compared with dead patients of MODS, the alive patients were younger and had lower incidence of acute rejection. When the number of organ failare were two, three and four, the mortality of patients were 40%, 75%, 100%, respectively. As the scores of MODS were 0-4, 5-7 and 8, the mortality were 40%, 57.1% and 100%, respectively. Conclusions The high risk factors for MODS after renal transplantation are old age, the occurrence of acute rejection and use of steroid pulse treatment, ATG and OKT3. The high risk factors for dear of patients with MODS include the scores of MODS, the number of organ failure, old age, the occurrence of aulte rehection and use of steroid pulse treatment, ATG and OKT3. The primary factors for the oamreuce of MODS in patients after renal transplantation are lung infection, delayed recovery of transplanted renal function and haemorrhage of digestive system.
出处
《北京医学》
CAS
2009年第4期197-200,共4页
Beijing Medical Journal
