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目的 探讨伴发肾功能不全的多脏器功能障碍综合征 (MODS)患者的临床特征及预后。方法 对一综合性ICU中 6 0例MODS患者的临床特征进行回顾性分析 ,并比较了入院时APACHEⅡ评分、序贯器官衰竭估计 (sequentialorganfailureassessment,SOFA)评分对预后的预测作用。结果 6 0例MODS患者中发生肾功能不全 4 5例 (75 % ) ,未发生肾功能不全 15例 (2 5 % ) ,二组比较病死率无差异 ,但发生肾功能不全组器官衰竭个数、最大SOFA评分明显高于未发生肾功能不全组 (P <0 0 1)。在发生肾功能不全的患者中存活组与死亡组临床特征比较显示 ,两组在少尿、休克的存在、行机械通气治疗、器官衰竭的个数、入院后肾功能不全出现的时间、入院肾SOFA评分、肾最大SOFA评分及总最大SOFA评分差异有显著意义(P <0 0 5 )。少尿组与非少尿组患者临床特征比较显示少尿组患者病死率、器官衰谒个数、总最大SOAF评分、肾最大SOFA评分明显高于非少尿组 (P <0 0 1)。结论 在MODS中肾脏损害较普遍。伴发肾功能不全的MODS患者中影响预后的因素主要有少尿、休克的存在、行机械通气治疗、器官衰竭的个数、迟发的肾功能衰竭。SOAF评分对估计MODS患者的病情及预测预后具有良好的临床应用价值。
Objective To investigate the clinical features and prognosis of multiple organ dysfunction syndrome (MODS) with renal insufficiency. Methods The clinical features of 60 MODS patients in a comprehensive ICU were retrospectively analyzed. The APACHE Ⅱ score and sequential organ failure assessment (SOFA) score on admission were compared to predict the prognosis. Results In 60 MODS patients, 45 cases (75%) had renal insufficiency and 15 cases (25%) did not have renal insufficiency. There was no difference in mortality between the two groups, but the number of organ failure in renal dysfunction group , The maximum SOFA score was significantly higher than the group without renal insufficiency (P <0.01). The clinical features of survivors and deaths in patients with renal insufficiency showed that the presence of oliguria, shock, mechanical ventilation, the number of organ failure, the time of admission after renal insufficiency, There was significant difference between SOFA score, maximal renal SOFA score and total maximal SOFA score (P <0.05). The clinical features of patients with oliguria and non-oliguria showed that patients with oliguria mortality, organ failure, the total maximum SOAF score, renal maximum SOFA score was significantly higher than non-oliguric group (P <0.01). Conclusion Kidney damage is more common in MODS. The main prognostic factors in MODS patients with renal insufficiency are oliguria, shock, mechanical ventilation, the number of organ failure, and delayed renal failure. SOAF score for the assessment of MODS patients with disease and prognosis has good clinical value.