83例多器官功能障碍综合征患者流行病学分析

An Epidemiological Analysis of 83 Cases of Multiple Organ Dysfunction Syndrome

目的：调查和分析广东省中医院内科ICU病房83例多器官功能障碍综合征（MODS）患者病因构成、病死率、中医证型情况。方法：采集广东省中医院内科ICU病房2010～2011年中MODS病史资料83例，观察指标包括性别、年龄、MODS原发病因、急性生理学与慢性健康状况评分系统（APACHEⅡ）分值、中医证型分布、病死率情况，并进行分析。结果：收治的MODS患者中，原发病包括严重脓毒症、低血容量休克、重症胰腺炎致全身炎症反应综合征等，其中脓毒症占63．9％，低血容量休克8．4％，胰腺炎占15．7％，其他（心肺复苏术后、心脑血管疾病、肺栓塞、重症药疹等）占12．1％。83例患者中存活54例，死亡29例，病死率34．9％。实证主要以毒邪内盛证、瘀血内阻证、痰热内蕴证、肺热腑实证为主，虚证主要以阴耗竭证、阳气暴脱证、内闭外脱证为主，虚实二证病死率比较，差异有显著性意义（P〈0．05）。结论：广东省中医院内科ICU收治MODS患者病因以脓毒症最为常见，其次是重症胰腺炎，中医实证与虚证之间的病死率有差别，虚证患者死亡率较高。

Objective： To investigate the causes, mortalities, traditional Chinese medical syndrome types of 83 patients with multiple organ dysfunction syndrome （ MODS ） in intensive care unit（ICU） of Guangdong Provincial Hospital of Traditional Chinese Medicine. Methods- The clinical record of 83 MODS patients in ICU of Guangdong Provincial Hospital of Traditional Chinese Medicine from 2010 to 2011 was collected. The data including case gender and age, primary causes for MODS, acute physiology and APACHE II scores, traditional Chinese medical syndrome types, and case fatality were analyzed. Results= Primary diseases of 83 MODS patients included severe sepsis, hypovolemic shock, and severe pancreatitis induced systemic inflammatory response syndrome（SIRS）. Sepsis accounted for 63.9%, hypovolemic shock accounted for 8.4%, pancreatitis accounted for 15.7%, and others diseases such as post-cardiopulmonary resuscitation disorder, cardiac and cerebral vascular diseases, pulmonary embolism and severe drug rash accounted for 12.1%. Of the 83 patients, 54 were survival, 29 were dead, and the case fatality was 34.9%. The excess syndromes of MODS were dominated by internal accumulation of toxicity, blood-stasis blockage, accumulation of phlegm heat, and lung heat with fu-organ excess. The deficiency syndromes of MODS were dominated by exhaustion of yin fluid, sudden collapse of yang qi, and unconsciousness with collapse. The difference of case fatality was significant between the excess syndromes and deficiency syndromes （P 〈 0.05）. Conclusion= The most commonly-seen etiology of MQDS in ICU of Guangdong Provincial Hospital of Traditional Chinese Medicine is sepsis, and severe pancreatitis comes next. The case fatality varies in MODS patients with excess syndromes and deficiency syndromes, and patients with deficiency syndromes has higher mortality rate.