创伤性多器官衰竭临床诊断及防治——附26例临床报告

Clinical diagnosis, prevention and treatment of traumatic multiple organ failure: A report of 26 cases

目的 探讨创伤引起多器官衰竭（ＭＯＦ） 的诊断和防治。方法 回顾分析了我院近７ 年来收治的多发性创伤引起的２６ 例ＭＯＦ患者，在去除病因并积极支持各主要器官功能基础上，联合大剂量应用地塞米松（４０ ｍｇ／８ ｈ）、６５４ －２（２０ ｍｇ／８ ｈ） 连续５ 天。并对不同组别及不同预后的患者检测血浆肿瘤坏死因子（ＴＮＦ），并进行对比。结果 ２６ 例患者各器官衰竭发生率分别为：肺５３－９ ％ ，心血管３０－８ ％ ，肾１９－２％ ，肝１６－７％ ，消化道１１－５ ％ ，中枢神经７－７ ％ ；器官衰竭数与病死率的关系为：２ 个器官衰竭病死率２／８ ；３ 个，６３－６％ ；≥４ 个，６／７ ；总病死率５７－７ ％ 。非ＭＯＦ病死率１４－３ ％ 。ＭＯＦ组ＴＮＦ水平明显高于非ＭＯＦ 组（ Ｐ＜ ０－０１） ；而ＭＯＦ者中死亡组的ＴＮＦ水平也明显高于存活组（ Ｐ＜０－０５） 。结论 （１）在多发性创伤中，ＴＮＦ水平升高与ＭＯＦ的发生及发展有密切的关系；（２） 衰竭器官的数量越多，病死率越高；（３） 联合大剂量应用地塞米松、６５４ － ２ ，对防治ＭＯＦ有重要作用。

Objective To explore the diagnosis, prevention and treatment of multiple organ failure (MOF) caused by trauma. Methods Twenty six cases of MOF caused by multiple trauma in our hospital from 1992～1999 were retrospectively analysed. On the basis of getting rid of pathogenic factors and supporting the function of each main organ, large doses of dexamethasone (40 mg/8 h) and 654-2(20 mg/8 h) were also given for 5 days. Tumor necrosis factor (TNF) level was measured in different groups. Results The morbidity of each organ failure in 26 cases was lung 53 9%, circulation 30 8%,kidney 19 2%, liver 16 7%,digestive tract 11 5%, central nerve 7 7% respectively. The mortality of different failure organ numbers was 2/8 in two failure organs, 63 6% in three, 6/7 in four or more and 14 3% in non MOF. TNF level increased significantly in MOF group than that in non MOF, as well, in death cases of MOF than that in survival ones of MOF. Conclusion (1)In multiple trauma, the rise of plasma tumor necrosis factor(TNF) level has a close relation with the occurrence of MOF. TNF may play an important role in the occurrence of MOF. (2) The more the number of failure organs is, the higher the mortality is. (3)On the basis of actively getting rid of pathogenic factors and supporting the function of each main organ, large doses of dexamethasone and 654-2 may be important for prevention and treatment of MOF.