危重烧伤后多器官功能障碍综合征的诊断与治疗探讨

The diagnosis and treatment of multiple organ dysfunction syndrome after severe burns

目的 :探讨危重烧伤后多器官功能障碍综合征 (MODS)早期诊断与治疗方法的改进措施。方法 :根据烧伤发病时间将 133例 MODS患者分为对照组和治疗组。对照组采用原 Fry和山本保博等提出的多器官衰竭(MOF)诊断标准及单纯液体复苏为主的治疗方法 ,治疗组采用以 Sauaia和王今达等提出并经作者改进后的MODS诊断标准与治疗方法 ,比较 2组间 MODS发病率、确诊时间、并发症及病死率的差异。结果 :修订后的MODS诊断标准较 MOF标准的确诊时间提前 ;治疗方法改进后 ,组间治疗的结果经统计学处理有显著差异(P<0 .0 5 )。结论 :原 MOF的诊断标准已不适用于 MODS的早期诊断 ,全身炎症反应综合征 (SIRS)的引入和观察有利于 MODS的早期诊断。在治疗中应果断去除“二次打击”的致病因素 ,坚持早期液体复苏和“二抗三同步”治疗方法 ,有利于提高

Objective:To investigate the improved diagnosis and treatment of multiple organ dysfunction syndrome (MODS) after severe burns.Methods:One hundred and thirtythree patients were divided into control and treatment groups.Comparison was made between two groups,including incidence of MODS,diagnosis time,complications,and mortality rate.Results:The diagnosis time of MODS was shortened by use of revised criteria for MODS compared with the standard criteria for multiple organ failure(MOF).By improved treatment methods,clinical results between two groups were markedly different ( P <0 05).Conclusions:Early recognition of systemic inflammatory response syndrome(SIRS) and MODS should be introduced into the criteria for MODS.Elimination of twohit factors,early resuscitation,and application of so called 'two antagonism and three synchronization methods' are effective measures to improve the successful treatment of MODS.