消化内科患者合并休克回顾性分析105例

Gastroenterology patients with shock: An analysis of 105 cases

目的:探讨消化内科患者合并休克的特点及治疗、预后.方法:回顾性分析2013-01/2014-06汕头市第二人民医院消化内科105例休克患者临床资料.结果:急性胰腺炎121例,合并休克11例,发病率9.090%;消化系出血681例,合并休克61例,发病率8.957%;急性胃肠炎148例,合并休克9例,发病率6.081%;急性胆囊炎、胆管炎653例,合并休克24例,发病率3.675%.四者比较有统计学差异(χ2=16.5928,P<0.05).105例患者转科52例(49.52%),死亡12例(11.43%).其中:感染性休克32例,转科28例(87.50%),死亡5例(15.63%);低血容量性休克65例,转科18例(27.69%),死亡6例(9.23%);心源性休克6例,转科6例(100%),死亡1例(16.67%);过敏性休克2例,转科及死亡均为0.四者转科比较有统计学差异(χ2=38.9325,P<0.05);死亡率比较有统计学差异(χ2=106.2876,P<0.05).结论:急性感染性、出血性疾病是消化内科患者合并休克最重要的原发病;心源性休克的死亡率最高,感染性休克次之,然后是低血容量性休克,过敏性休克及时抢救大多获得成功.加强危重患者监护,早诊断,早治疗,多学科联合协作,才能提高抢救成功率、减少死亡率.

AIM： To investigate the clinical characteristics, treatment and prognosis of gastroenterology pa- tients with shock. METHODS： Clinical data for 105 gastroenterolo- gy patients with shock treated at our department from January 2013 to June 2014 were analyzed retrospectively. RESULTS： The incidence of shock was 9.090% （11/121） in patients with acute pancreatitis, 8.957% （61/681） in patients with digestive tract hemorrhage, 6.081% （9/148） in patients with shock, and 3.675% （24/653） in patients with acute cholecystitis or cholangitis. There was a significant difference in the incidence of shock among the above four groups of patients （2 = 16.5928, P 〈 0.05）. Of the 105 shock patients, 52 （49.52%） were referred and 12 （11.43%） died. Of 32 cases with infectious shock, 28 （87.50%）were referred and 5 （15.63%） died. Of 65 cases with shock due to severe blood loss, 18 （27.69%） were referred and 6 （9.23%） died. Of 6 cases with cardiac shock, all （100%） were referred and 1 （16.67%） died. Of two cases with anaphylactic shock, no referral or death occurred. The rates of referral and death were statistically significant among different groups （2 = 38.9325, P 〈 0.05; X2=106.2876, P 〈 0.05）. CONCLUSION： Acute infectious, hemorrhagic disease is the most important primary disease combined with shock. Cardiogenic shock is as- sociated with the highest mortality, followed by septic shock, hypovolemic shock and anaphy- lactic shock. Timely rescue is successful in the majority of cases. Strengthened care of critically ill patients, early diagnosis and treatment, and multidisciplinary collaboration can improve the rescue success rate and reduce mortality.