摘要
AIMS We report 15 cases of abdominal-surgical multiple organ failure(MOF)treated successfully by a new combined therapy four high doses in volume and one support“FHDOS”short period high doses in large volume anJsodaminum;short period high doses in large volume dexamethasonum;high doses in large volume of dis- infectant antibiotics;high doses in large volume of abdominal cav- ity washing liquor and support of nutrition metabolism.The mortal- ity rate and cost of MOF were decreased.It is simple,practical and effective. METHODS The study group consisted of 15 patients(10 wom- en,5 men;average age,42.7)who were hospitalized in our hospital.All patients were given“FHDOS”:short period high in large volume Anisodaminum:intravenous injection 40 mg once; another 40rag may be added 30 minutes later according to condition.The total amount may reach 120-240 mg a day,or,in- travenous injection 40 mg every 15 minutes until condition being under control.Short period high doses in large volume Dexamethasonum:intravenous injection 100-200 mg once;this remedy may be continued for 1-3 days;the amount also may de- crease according to condition.High doses in large volume of dis- infectant Antibiotics:select and use antibiotics according to clini- cal condition,inference of Gram's stain;it is necessary to re- peatedly culture bacteria in many parts,and then,to make ad- justment according to culture result and drug-resistance,and to prevent carefully the dual infections from occurring.High doses in large volume of abdominal cavity washing liquor:generally adopt- ing physiological saline 6000o8000ml in washing abdominal cavity. “One support”means full support of nutrition metabolism. RESULTS All the patients in this group survive well after the rescue without any complication. CONCLUSIONS MOF should be prevented,if possible,by stopping or controlling the injury,removing as much necrotic tis- sue as possible,improving blood flow and oxygen consumption, supporting metabolism,and preventing infection or treating it ear- ly and adequately.“FHDOS”is a combined therapy and plays a key role in treating MOF.
目的研究“四大一支持”综合疗法治疗多器官功能衰竭的实用、有效的价值。方法本组15例患者,男10例,女5例。均应用“四大一支持”综合疗法:①短程大剂量山莨菪硷:一次静注40 mg,30 min 后根据病情追加40 mg,总量有的可达120-240 mg/d。或者每隔15 min 静注30 mg,直到病情控制。②短程大剂量地塞米松:一次静注100-200 mg,也可在危急情况下静脉小壶注入,应根据病情需要,可连续用药1-3 d。也可逐渐减量。③大剂量杀菌性抗生素正确合理应用;根据临床情况、感染源的推测,如有可能最好做革兰氏染色以指导选用抗生素,从多个地方反复做细菌培养是必要的,随后应按照培养结果和耐药性予以调整,并警惕和预防二重感染的发生。联合用药一般针对革兰氏阳性菌的一代头孢菌素加用抗厌氧菌感染的甲硝唑等。④大剂量应用腹腔灌洗液清洗腹腔:一般采用1:1000新洁尔灭1000-2000 ml 生理盐水2000—3000 ml冲洗腹腔,也可根据病情需要,应用不同的灌洗液行腹腔灌洗。⑤一支持即完全的代谢营养支持:代谢营养支持的方法可分肠外(TPN)和肠内(TEN)两大类。结果本组患者全部恢复无并发症。结论一旦发生 MOF,要给予强有力的“四大一支持”综合疗法,临床证实本疗法在腹部外科 MOF 患者救治中具有实用、有效的价值。
