重度颅脑外伤并发MODS的临床救治研究

Clinical treatment of multiple organ dysfunction syndrome following severe craniocerebral injury

目的 :探讨重度颅脑外伤并发多器官功能障碍综合征 (MODS)的发病机制与综合治疗方法。方法 :回顾性分析 1995— 2 0 0 0年来我院 NICU中收治的重度颅脑外伤并发 MODS患者 43例的临床资料。结果 :197例重度颅脑外伤患者救治过程中出现 MODS 43例 (发生率为 2 1.83% ) ,其中死亡 2 8例 (病死率 6 5 .12 % ) ;发生肺功能障碍 2 8例 (发生率 6 5 .12 % )。此外 ,广泛脑实质的损伤、脑疝的发生、入院时的低格拉斯哥昏迷评分是发生 MODS的危险因素 ;脑干与下丘脑的损害是 MODS发生的始动因素。结论 :及时有效地缓解颅高压、恢复脑干功能是治疗的首要问题 ;而肺部并发症的合理治疗是控制 MODS的重要环节 ;

Objective:To study the potential mechanisms and comprehensive treatment measures for patients who suffered from multiple organ dysfunction syndrome (MODS) complicating severe craniocerebral injury.Methods:Retrospective analysis was performed on the clinical data of patient with MODS complicating severe brain injury in our NICU from 1995 to 2000 years. Appropriate treatment measures were given according to clinical manifestations of different organ damage.Results:In 197 patients with severe brain injury,MODS developed in 43 patients,and the mortality of patients with MODS was 65 12%.The incidence of pulmonary complication was the highest among various organs (93%).Furthermore,analysis identified the following risk factors:diffuse brain parenchymal damage,herniation,and low GCS score.Brain stem and hypothalamus injuries were initial factors resulting in MODS.Conclusions:It should be emphasized to ameliorate intracranial hypertension,and to effectively and timely recover the function of brain stem.Rational treatment to pulmonary complication plays a key role to prevent MODS.The mortality of MODS can be reduced by use of combined treatment strategy.