重症脑功能损伤并发多器官功能障碍及其预后

Severe brain impairment complicated by multiple organ dysfunction syndrome and prognosis

目的 :了解脑损伤并发多器官功能障碍的发生发展规律 ,为加强多器官系统功能的保护与治疗提供依据。方法 :急性脑功能损伤 189例 ,按格拉斯哥昏迷评分 (GCS)分为重症组 (131例 )和非重症组 (5 8例 ) ,对 2组进行各器官功能障碍的比较性研究。结果 :重症组 4个脑外器官功能障碍高于非重症组 (P<0 .0 5 )。重症组器官功能障碍率最高的是代谢功能紊乱 (高血糖 6 6 .3% ,低蛋白血症 2 8.3% )和肺功能障碍 (6 4 .9% ) ,其次是胃肠功能障碍 (49.6 % )和肾功能障碍 (16 .8% )。重症组并发严重感染的问题更加突出 (77.1% ) ,特别是下呼吸道感染。重症组符合多器官功能障碍综合征 (MODS)诊断标准的占 80 .1% ,脑外 2～ 4个器官损伤的例数最多 ,占 MODS的 85 .7% ,器官损伤数目越多 ,预后越差。结论 :重症脑功能损伤的监测与救治必须着眼于整个机体多器官系统。

Objective:To understand the mechanism underlying the development of multiple organ dysfunction syndrome(MODS) in patients with severe brain impairment and provide evidence for enhancing the protection of the function of multiple organs in these patients.Methods:One hundred and eightynine patients with acute brain impairment were divided into severe group (131 cases) and nonsevere group (58 cases) according to Glasgow coma scale(GCS) and their multiple organ functions were compared.Results:The incidence of MODS in the severe group was more often than the nonsevere group ( P <0 05),and the most frequently occurring multiple organ damage included metabolism disorders (hyperglycemia 66 3%,hypoproteinemia 28 3%) and pulmonary dysfunction(64 9%),others were gastrointestinal (49 6%) and renal dysfunction(16 8%).The severe infection was more prominent in the severe group (77 1%),especially for lower respiratory tract infection.In the severe group 80 1% of the patiants were in coincidence with MODS diagnosis and those with 24 organs damage accounted for 85 7% of MODS,and the patients with more organs involved had the worse prognosis.Conclusions:The monitoring and treating of severe brain function impairment should focus on multiple organ system.