重症肺结核并发多器官功能衰竭临床分析

Clinical analysis of 116 cases of severe pulmonary tuberculosis complicated with multiple organ failure

目的探讨重症肺结核并发多器官功能衰竭(MOF)临床特点和防治措施。方法对我院1998-09～2003-10收治的116例重症肺结核并发MOF患者进行回顾性分析。结果116例重症肺结核并发MOF患者中93.1%为复治病例,以肺部感染为诱因者占72.4%,以肺为首发衰竭器官占76.7%。各器官衰竭发生率依次为肺87.9%、心脏80.2%、脑48.3%、肝脏30.2%、肾28.4%、消化道19.0%、血液3.4%。并发MOF病死率为62.1%。各年龄组病死率分别为青年组22.2%、中年组54.2%、老年组74.6%。并发2个器官衰竭病死率为44.2%,3个器官衰竭病死率为64.1%,4个器官衰竭病死率为90.0%,5个器官衰竭病死率为100.0%。结论重症肺结核易并发MOF,肺部感染为主要诱因,多先出现呼吸衰竭,进而导致MOF,病死率高。积极预防,综合治疗为主要措施。

Objective To investigate the clinical characteristics and measures of prevention&treatment in severe pulmonary tuberculosis complicated with multiple organ failure (MOF).Methods The116patients with severe pulmonary tuberculosis complicated with MOF were analyzed retrospectively.Results Among the116cases,93.1%were retreated pulmonary tuberculosis cases,72.4%were precipitated by pulmonary infections,76.7%of primary failure organ s were in lung.The rates of organ failure in lung,heart,brain,liver,kidney,digestive tract and blood were87.9%,80.2%,48.3%,30.2%,28.4%,19.0%and3.4%,respectively.The mortality rate was62.1%in patients complicated with MOF.The mortality rates in youth,middle-aged and old-aged groups were22.2%,56.3%and72.9%,respectively.The mortality rates of MOF with organs of2,3,4and5were44.2%,64.1%,90%and100%,respectively.Conclusion Severe pulmonary tuberculosis is liable to complicate with MOF,and mainly precipitated by pulmonary infections.Respiratory failure is generally appeared first,then,MOF follows,and its mortality rate is very high.The dominant measures are active prevention and comprehensive treatment.