先天性心脏病手术后并发多脏器功能障碍综合征的临床分析

Clinical analysis of multiple organ dysfunction syndrome in children after cardiac surgery

目的总结小儿心脏手术后多脏器功能障碍综合征(MODS)病例的临床特点,探讨发生MODS患者中导致死亡的危险因素和防治措施。方法收集2001年1月至2010年12月本科先天性心脏病术后并发MODS患者35例,男21例,女14例;年龄(6.43±4.65)岁;体重(16.52±9.12)kg。将其中并发MODS的患者分为死亡组与存活组,进行比较,回顾性分析导致死亡的高危因素,总结脏器衰竭数目及MODS评分与病死率的关系。结果本组病死率为51.4%(18/35)。①受累器官的发生率依次为心脏100.0%(35/35)、肺脏80.0%(28/35)、肾脏60.0%(21/35)、肝脏14.3%(5/35)、血液系统11.4%(4/35)及中枢神经系统5.7%(2/35),其中心、肺出现受损的时间最早。②脏器衰竭数目在2、3、4、≥5个时对应的病死率分别是25.0%、45.5%、77.7%、100.0%;MODS评分与本组病死率亦呈显著正相关。③与存活患者相比,死亡患者体外循环时间、主动脉阻断时间明显延长,二次转机、围术期意外事件发生率显著增高(P<0.01)。结论心肺功能受损是导致小儿心脏术后MODS的原发病,MODS死亡率随脏器衰竭数目和MODS评分的增加而递增,死亡的高危因素为体外循环时间及二次转机、围术期意外事件,重在预防。

Objective To investigate the high risk factors and methods for prevention and treatment of multiple organ dysfunc- tion syndrome （MODS） in children after cardiopulmonary bypass （CPB）. Methods From Jan. 2001 to Dec. 2010, there were total 35 children （21 males and 14 females） complicated with MODS after cardiac surgery in our department, and these cases were divided into two groups： death group and survival group. The high risk factors results in death, and the relationship between the MODS score and the fatality rate were compared and analyzed. Results The overall mortality rate was 51.4% （18/35）. （1） The incidence rate of cardiovascular, respiratory, renal, hepatic, hematologic and neurologic dysfunction was 100. 0% （35/35）, 80.0% （28/35）, 60.0% （21/35）, 14.3% （5/35）, 11.4% （4/35） and 5.7% （2/35） respectively. Cardiac and respiratory injury appeared much earlier than other organs. （2） The more dysfunction organ systems presented, the higher mortality rate of patients would be. Furthermore, there was a significant positive correlation between clinic score and mortality rate. （3） Compared with survivals group, the death group had longer CPB time, longer aortic clamping time and higher incidence of repeat CPB support during surgery and perioperative unexpected events （ P 〈 O. O1 ）. Conclusion Cardiac and respiratory dysfunction are the primary diseases in children with MODS after CPB. Mortality associated with MODS is highly correlated with the number of organ failing and clinical score. The high risk factors for the death of pa- tients with MODS are the CPB time, incidence of repeat CPB support during surgery and perioperative unexpected events.