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目的 :总结探讨重症胆管炎 (AOSC)合并多脏器功能障碍综合征 (MODS)的临床特征及综合处理方法。方法 :对本院ICU近四年来收治 30例AOSC的主要临床特征及诊治要点进行回顾分析。结果 :本组病例中累及单一、两个、三个、四个及五个脏器功能障碍的发生率分别为 2 3 3%、 2 6 7%、 12 5 %、 16 7%和 2 0 0 % ,其死亡率分别为 0、 12 5 %、 2 0 0 %、 6 6 7%及 10 0 % ;MODS发生率为 76 7% ,总病死率为 36 7%。循环系统功能障碍发生率最高 ,其他依次为呼吸、血液、肝脏、肾脏、消化道、神经及代谢系统。凡病人年龄≥ 6 0岁、入院 2 4h内A PACHEⅡ评分≥ 16分、血红蛋白 <10 0g/L、血小板计数 <10 0× 10 9/L、血浆白蛋白 <30g/L、血浆直接胆红素≥ 10 0 μmol/L、发病至治疗时间≥ 72h及入院时有休克者 ,易产生MODS ,其病死率相对为高。结论 :成功抢救AOSC的重要措施包括及时解除胆道梗阻、有效地控制感染以去除MODS的始动和促使因子 ,并在监护病房内对病人进行严密监护和各脏器功能及营养代谢支持治疗 ,以降低MODS的发生率及病死率。
Objective: To summarize the clinical features and comprehensive treatment of severe cholangitis (AOSC) complicated with multiple organ dysfunction syndrome (MODS). Methods: The main clinical features and diagnosis and treatment of 30 cases of AOSC treated in our hospital for nearly four years were retrospectively analyzed. Results: The incidences of single, two, three, four and five organ dysfunction in this group were 23.3%, 26.7%, 125%, 167% and 200% respectively The mortality rates were 0,125%, 200%, 66,7% and 100% respectively. The incidence of MODS was 76.7% and the total mortality was 36.7%. Circulatory system dysfunction occurred most frequently, followed by breathing, blood, liver, kidneys, digestive tract, nerves and metabolic system. Where the patient age ≥ 60 years old, within 24 hours of admission A PACHE Ⅱ score ≥ 16 points, hemoglobin <10 0g / L, platelet count <10 0 × 10 9 / L, serum albumin <30g / L, plasma direct bilirubin ≥10 0 μmol / L, morbidity to treatment time ≥72h and shock at admission, easy to produce MODS, the mortality is relatively high. Conclusion: The important measures for successful rescue of AOSC include timely relief of biliary obstruction, effective control of infection to remove the initiating and promoting factors of MODS, intensive monitoring of patients in the intensive care unit, support of various organ functions and nutritional metabolism, Reduce the incidence of MODS and mortality.