急性脑卒中并老年人多器官功能衰竭的临床特点、发病因素及临床防治

Clinical features, pathogenic factors, clinical prevention and treatment of elderly acute brain stroke with multiple organ failure

目的探讨急性脑卒中并老年人多器官功能衰竭的临床特点、发病因素及临床防治措施。方法回顾性选取该院确诊收治的急性脑卒中并老年人多器官功能衰竭患者120例,根据颅脑CT检查结果分为两组:脑出血组(n=79),脑卒中组(n=41)。对两组患者的致死率、原患基础病的发生情况、不同脏器衰竭的发生数目及病死率进行统计学分析。结果脑出血组并发老年多器官功能衰竭(MOFE)的致死率显著高于脑卒中组(64.56%vs.56.10%,P<0.05),且致死率随患者年龄增加而升高。两组患者原患基础病均以高血压最多,脑出血组高血压的发生率显著低于脑卒中组(65.82%vs.78.05%,P<0.05)。120例患者中首发衰竭器官依次为心、肺、消化道、肝脏、代谢系统及肾脏,多发性衰竭器官(器官衰竭数目2~4个)以肺心占主导地位,且致死率最高。结论患者年龄以及原患高血压是影响急性脑卒中并发MOFE的重要因素,且发病后易引发以肺心为主的多器官功能衰竭,因此同时监控原患基础病和发病后引起的器官衰竭,对有效治疗急性脑卒中具有重要意义。

【Objective】To explore the clinical features, pathogenic factors, clinical prevention and treatment of acute brain stroke with multiple organ failure in the elderly（MOFE）.【Methods】A total of 120 MOFE patients were divided into two groups according to skull CT scanning： cerebral hemorrhage group（n =79） and brain stroke group（n =41）. The patient fatality rate, the incidence rate of original underlying diseases, the mortality and number of different organ failure were analyzed by statistical software.【Results】The patient fatality rate of cerebral hemorrhage group was significantly higher than that of brain stroke group（64.56% vs. 56.10%, P 0.05）, and the fatality rate rose with patients＇ age increasing. The most common original underlying disease of all patients was high blood pressure, and the incidence rate of high blood pressure of cerebral hemorrhage group was significantly lower than that of the brain stroke group（65.82% vs. 78.05%, P 0.05）. The first organ to fail was followed by heart, lung, digestive tract, liver, metabolic system, kidney. The multiple organ failure was dominated by heart and lung, and the mortality was the highest. 【Conclusion】The patient age and original high blood pressure are important factors affecting acute brain stroke with MOFE, and it can easily lead to multi-organ failure dominated by heart and lung, while monitoring the original underlying diseases and organ failure will have important effect for treatment of acute cerebral stroke.