多器官功能障碍综合征诊断标准与病情严重度评分系统的多中心临床研究

Multicenter clinical study on the diagnostic criteria for multiple organ dysfunction syndrome with illness severity score system

目的 通过分析国内多器官功能障碍综合征 ( MODS)病例资料 ,建立适合中国国情的 MODS诊断标准及病情严重度评分系统。方法 对北京市 8家三级综合医院的 4 13例 MODS患者的病历资料进行回顾性队列研究。分析死亡组和存活组间反映各个器官功能的各项指标是否存在显著性差异 ,选择有差异的指标作为候选指标 ,将各指标异常程度分为 4个间隔 ,分别赋予相应的等级分值 ,最终建立诊断标准草案。结果 MODS原发病因仍然是重症感染、创伤、大手术后、重症胰腺炎。 4 13例 MODS患者总住院病死率为5 3.5 % ( 2 2 1/ 4 13例 ) ,住院 2 8d内病死率为 37.3% ( 15 4 / 4 13例 ) ;发生 2～ 6个器官功能障碍者的病死率为2 8.6 %～ 10 0 .0 % ;住院第 1周内并发脑、心、肾、呼吸功能障碍者病死率分别为 72 .8%、6 4 .3%、6 1.7%和5 4 .7%。治疗中呼吸机使用频率为 76 .0 % ,而透析的应用频率为 8.2 %。建立了 MODS诊断标准、病情严重度评分系统草案 :主要纳入呼吸、心血管、肾脏、凝血、脑、肝脏、胃肠道 7个脏器系统 ,每个脏器系统仅用 1个指标表示其功能障碍与否 ,分别是氧合指数、收缩压、血清肌酐浓度、血小板计数、意识状态、血清总胆红素浓度、排便状况 ;每个指标结合病情严重程度分别赋予 0～ 4分 ,0分为功能正?

Objective To establish the diagnostic criteria for multiple organ dysfunction syndrome(MODS) with illness severity score according to the evaluation of clinical MODS data from hosptal in Beijing. Methods The clinical data from 413 MODS cases in eight hospitals with Ⅲleve in Beijing, was analyzed by multicenter retrospective cohort study. The significant difference of the each descriptor between non survivor group and survivor group was analyzed, then the significant descriptor was selected as the potential indicator. Based on the above analysis, the abnormal range of each descriptor was divided into 4 intervals, assigned corresponding points, diagnostic criteria for MODS was established. Results Severe infection, major operations, trauma and severe pancreatitis were the main etiological factor for MODS. The mortality of MODS in hospital was 53 5%, and the mortality rate for 28 days hospitalization was 37 3%. The correspondent mortality rate in MODS with 26 dysfunction organ was 28 6%100 0%. The mortality rate of MODS complicated by the dysfunction of brain, cardiovascular system, kidney, and lung was 72 8%, 64 3%, 61 7%, and 54 7% respectively. The frequency of machinery ventilation support was 76 0% and the frequency of hemodialysis was 8 2%. The script of diagnostic criteria for MODS with the illness severity score system was established. The script mainly was involved in the evaluation of seven organs or systems, including respiratory system, cardiovascular system, kidney, hemologic system, liver and alimentary system. Only one parameter was used in each organ, they were FiO 2/PaO 2, systolic blood pressure(SBP), serum creatinine , platelet count, conscious state and the defecation status. 04 scores were endued with each index according to the severity of the illnesses respectively. Every descriptor was 5 points, showing 0 point with normal organ function, and 14 scores with organ dysfunction and aggravation. Conclusion The mortality of MODS in hospitals is 53 5% in Beijing. The main etiological factors for MODS still are severe infection, major operations, trauma and severe pancreatitis. The diagnostic criteria for MODS with the illness severity score and the prognostic evaluation system established might have clinical significance and practicability, but further studies with large samples are still needed.