老年脑出血昏迷患者继发多器官功能障碍综合征的相关因素分析

Relative factors of secondary MODS in elderly comatose patients due to cerebral hemorrhage

目的分析老年脑出血昏迷患者继发多器官功能障碍综合征(MODS)的相关影响因素,为有效防治老年脑出血昏迷患者继发MODS提供参考。方法采取前瞻性研究方法选择2013年1月至2014年12月收治的78例老年脑出血昏迷患者作为研究对象。入院后即行格拉斯哥昏迷评分(GCS),入院后24 h内进行急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评定,检测血清白细胞介素(IL)-1、IL-6、IL-10、C反应蛋白(CRP)、白蛋白、血糖水平,入院第1天开始监测患者MODS发生情况。采用t检验对MODS发生的危险因素进行单因素分析,采用多因素Logistic回归法分析MODS的独立危险因素。结果 78例患者中31例(39.74%)出现MODS,31例中死亡15例,多为3个及以上器官衰竭患者。单因素分析显示,血糖、IL-1、IL-10、CRP水平、APACHEⅡ评分、脑出血体积、GCS评分、血清白蛋白水平是老年脑出血昏迷患者发生MODS的影响因素(P<0.05,P<0.01)。多因素Logistic回归分析结果显示,APACHEⅡ评分高、脑出血体积大、血糖、IL-1、IL-10水平高及血清白蛋白水平低是老年脑出血昏迷患者继发MODS的独立危险因素(P<0.05,P<0.01)。结论炎症反应、血糖水平、脑出血体积、APACHEⅡ评分、营养状况与老年脑出血昏迷患者继发MODS密切相关,要改善患者全身状况,有效控制血糖水平,以减少MODS的发生。

Objective To analyze the related risk factors of secondary muhiple organ dysfunction syndrome （MODS） to provide clinical reference for effective prevention and treatment of elderly comatose patients due to cerebral hemon＇hage. Methods Using a prospective study method,78 elderly comatose patients due to cerebral hemorrhage received and cured from January 2013 to December 2014 were selected as the research objects. Glasgow Coma Scale （GCS） was performed immediately after admission;acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） within 24 h after admission was evaluated;serum levels of interleukin （IL） -1, IL-6, IL-10, C reactive protein （ CRP）, albumin, blood glucose were detected to observe the occurrence of MODS. From the first day after admission, occurrence situation of MODS was monitored. T test was used to carry out single factor analysis of influencing factors of MODS, and multivariate Logistic regression analysis was used to analyze the independent risk factors of MODS. Results There were 31 （39.74%） MODS patients in 78 elderly comatose patients with cerebral hemorrhage in whom 15 patients died due to multiple organ failure （MOF） of three or more organs. Univariate analysis showed that levels of blood glucose, IL-1, IL-10, CRP, scores of APACHE H , volume of cerebral hemorrhage, serum albumin level and GCS score were the influencing factors of MODS in elderly comatose patients due to cerebral hemorrhage （ P 〈 0.05, P 〈 0.01 ）. Multivariate Logistic regression analysis showed that high APACHE score, large cerebral hemorrhage volume, high levels of blood glucose, IL-1, IL-10 and low level of serum albumin were the independent risk factors of secondary MODS in the elderly comatose patients due to cerebral hemorrhage （ P 〈 0. 05, P 〈 0. 01 ）. Conclusions Inflammation response, blood glucose level, cerebral hemorrhage volume, APACHE score, and nutritional status are closely associated with secondary MODS in elderly comatose patients due to cerebral hemorrhage. It is necessary to improve the patient＇s general condition and control blood glucose level effectively for reducing the occurrence of MODS.