脓毒性休克的复苏与多器官功能障碍综合征早期防治的研究

Study on resuscitation of septic shock and early prophylaxis and treatment of multiply organ dysfunction syndrome

目的 评价修改后的复苏方案对脓毒性休克及多器官功能障碍综合征 (MODS)的防治效果。方法 总结 1995年 3月至 2 0 0 1年 8月收治的脓毒性休克患者 87例 ,对比分析修改后的方案与旧方案治疗脓毒性休克的疗效及MODS的发生率与病死率。修改后的方案主要是及时、快速、充分液体复苏 ,应用血管活性药物改善脏器灌注 ,氧自由基清除剂减少自由基损害 ,早期开展肠道内营养保护肠黏膜屏障。结果 采用新方案明显缩短了休克的纠正时间 ,降低了血浆中内毒素与肿瘤坏死因子 (TNF)的水平 ,减少了MODS的发生率与病死率。结论 修改后的复苏方案显著提高了复苏效率 ,有助于减少或消除MODS诱因 。

Objective To evaluate the effect of improved resuscitation measures on resuscitation of septic shock and early prophylaxis and treatment of multiply organ dysfunction syndrome(MODS).Methods 87 sepsis patients admitted to the clinical department from March 1995 through August 2001 were studied.Efficiency of septic shock and morbidity and mortality rates of MODS were compared between two groups of patients with and without improved resuscitation measures.These measures include:①prompt,rapid and adequate fluid resuscitation under hemodynamic monitoring with Swan-Ganz catheter.②rapid restoration of important organ circulation by treatment with cardiovascular drugs .③prevention of further oxygen free radicals(OFR)injury with OFR scavengers.④early enteral nutritional support to protect gastrointestinal mucosal barrier.Results With the application of the improved resuscitation measures,the duration of shock and the serum endotoxin and TNF level were decreased significantly.The morbidity and mortality rate of MODS was decreased from 57 14% to 17 87% (P<0 01) and 83 33% to 37 50%(P<0 05),respectively.Conclusion Improved resuscitation measures can effectively reduced duration of septic shock and decrease the occasion of MODS,which is redound to decrease morbidity and mortality rate of MODS