肾综合征出血热合并多器官功能衰竭460例临床分析

The clinical analysis of 460 cases of hemorrhagic fever with renal syndrome complicated by multiple organ dysfunction syndrome

目的:探讨肾综合征出血热合并多器官功能衰竭的发生机制、衰竭器官发生频率和临床分期及预后的相互关系。方法:回顾性分析我院近4年来460例肾综合征出血热合并多器官功能衰竭患者的临床资料。结果:460例患者中重型患者114例,危重型患者116例,死亡85例,病死率为18.5%。各个临床分期中发生器官衰竭数比例各不相同,在疾病的进展至低血压休克期和少尿期,出现多个脏器序贯衰竭的比例逐渐增加;病死率随着器官衰竭数的增加而呈正相关;发病年龄、发病后入院时间、有无血液透析或血液净化等因素与治愈率、死亡率显著相关。结论:保护易衰竭器官,及时防治休克、DIC、大出血、肾衰、水电解质紊乱和继发感染,避免或减少MODS的发生是治疗肾综合症出血热合并多器官衰竭的关键;为了提高肾综合征出血热的治愈率,应严格遵循"早发现、早休息、早治疗"的治疗原则,同时早期进行抗病毒治疗和使用免疫调节剂。

Objective： To investigate the mechanism,the relationship between dysfunction organ frequency and clinical stage or disease prognosis in hemorrhagic fever with renal syndromes（ HFRS） complicated by multiple organ dysfunction syndrome（ MODS）.Methods： We retrospectively analyzed clinical data of 460 patients with HFRS complicated by MODS in recent four years at our department. Results： There are 85 patients deceased in 460 patients,and the fatality rate of HFRS complicated by MODS was 18. 5%. The organ failure count ratio varies in various clinical stages. There are increased numbers of sequential organ failure in the hypotension and oliguria stages. The fatality rate correlated with the number of organ failure,and there are obvious relationship between the cure rate or mortality rate and the onset age,admission time after the onset of the disease,with or without hemodialysis or blood purification. Conclusion： In order to decrease the incidence and the death rate of HFRS complicated by MODS,principles such as early discovery,early rest,and early treatment should be emphasized and early antiviral therapy and the use of immunomodulatory agents should be realized.