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目的 探讨外科急腹症合并感染性或出血性休克时的临床处理。方法 回顾性分析 140例急腹症与休克的临床资料。结果 140例病人中感染性休克占 5 5 7% (78/ 140 ) ,原发病多为急性梗阻性化脓性胆管炎(AOSC) ;出血性休克占 44 3 % (6 2 / 140 ) ,多为外伤性肝脾破裂出血。抗休克治疗后 ,131例经手术治疗 ,治愈率为 6 8 7% (90 / 131) ,非手术治疗 9例 ,均死亡。治疗中发生急性呼吸窘迫综合征 (ARDS) 34例 ,总发生率为2 4 3 % (34/ 140 ) ,计感染性休克占 37 2 % (2 9/ 78) ,出血性休克占 8 1% (5 / 6 2 ) ,多发生在病程的 1～ 3天。发生急性肾功能衰竭 30例 ,发生率 2 1 4% (30 / 140 )。本组 140例病死率 35 7% (5 0 / 140 ) ,死亡主要原因为多脏器功能障碍综合征 (MODS)占 5 6 0 % (2 8/ 5 0 )。结论 外科急腹症合并休克时应首先紧急抗休克治疗 ,选择合适的手术时机及时手术是必要的 ,早期防治MODS可以降低其病死率。
Objective To investigate the clinical treatment of surgical acute abdomen with infectious or hemorrhagic shock. Methods A retrospective analysis of 140 cases of acute abdomen and shock clinical data. Results The septic shock in 140 patients was 57 57% (78/140). The primary disease was mostly acute obstructive suppurative cholangitis (AOSC). The hemorrhagic shock was 44 3% (62/14) For traumatic rupture of liver and spleen bleeding. After anti-shock treatment, 131 cases were surgically treated, the cure rate was 68.7% (90/131), and 9 cases were non-surgical treatment, all of whom died. In the treatment, ARDS occurred in 34 cases, with a total incidence of 23.4% (34/140), accounting for 37.2% (29/78) of septic shock and 81% of hemorrhagic shock (5/6 2), occurred in the course of 1 to 3 days. Acute renal failure occurred in 30 cases, the incidence of 214% (30/140). The group of 140 cases fatality rate of 35 7% (50/140), the main cause of death was multiple organ dysfunction syndrome (MODS) accounted for 56.0% (28/50). Conclusion Surgery for acute abdomen acute shock combined with shock should be the first emergency anti-shock treatment, select the appropriate timing of surgery and timely surgery is necessary, early prevention and treatment of MODS can reduce its mortality.