多器官功能障碍综合征诊断标准的多中心临床研究

摘要

Objective To develop diagnostic criteria of multiple organ dysfunction syndrome (MODS) by a prospective and multi-center clinical investigation. Methods The data of 1087 MODS cases obtained from ICU of 37 hospitals' from March 2002 to January 2005 in 11 provinces in China were analyzed in order to derive the diagnostic criteria of MODS. Results This MODS diagnostic criteria involved 7 organs. To diagnose MODS, the original cause of MODS should be identified, then there should be two or more organs showing signs of dysfunction. The criteria for organ dysfunction were as follows. (1) Cardiovascular system: SBP < 90 mm Hg( 1 mm Hg = 0. 133 kPa), MAP < 70 nun Hg, signs of shock, ventricular tachycardia, ventricular fibrillation, or myocardial infarction; (2) Respiratory system : oxygenation index <300 mm Hg; (3) Nervous system:indifference, restlessness, lethargy, light coma, or deep coma, Glasgow score≤14; (4) Blood system: PLT < 100 × 109/L; CT, APTT, and PT prolonged or shortened; positive plasma protamine paracoagulation ; (5) Liver: TBIL > 20. 5 μmol/L, ALB < 28 g/L; (6) Kidney : Cr > 123.8 μmol/L, urinary volume < 500 ml/24 h; (7) Gastro-intestine: bowel sounds decreased or disappeared ; retention in the stomach, or positive occult blood feces with dark stools or haematemesis; intra-abdominal pressure (intravesical pressure) ≥11 cm H2O( 1 cm H2O =0. 098 kPa), Any organ function met with one of the above conditions was considered to have dysfunction. Conclusions This diagnostic criterion of multiple organ dysfunction syndrome has been developed by this research, but it needs to accumulate experience by clinical practice and to revise the diagnosis criteria.%目的 通过多中心临床研究的方法 制定多器官功能障碍综合征(MODS)诊断标准.方法 收集2002年3月至2005年1月国内11个省市、37家三级医院ICU收治的1087例MODS病例的临床资料并进行统计学分析,筛选出反映器官功能并与预后相关的指标,据此制定MODS诊断标准草案.结果 本诊断标准纳入7个器官系统,在有引起MODS的原发病因的前提下,如果2个或者2个以上器官或系统功能达到下述标准,则可诊断为MODS.器官功能障碍与否的判定标准:(1)循环系统:SBP(收缩压)<90 mm Hg(1 mm Hg=0.133 kPa),MAP(平均动脉压)<70 mm Hg,发生休克、窒性心动过速或室颤等严重心律失常、心肌梗死;(2)呼吸系统:氧合指数<300 mm Hg;(3)神经系统:意识出现淡漠或躁动、嗜睡、浅昏迷、深昏迷;Glasgow昏迷评分≤14;(4)血液系统:血PLT(血小板计数)<100×109/L;血CT(凝血时间)、血APTT(活化的凝血酶原时间)、PT(凝血酶原时间)延长或缩短;3P试验阳性;(5)肝脏:血TBIL(总胆红素)>20.5 μmol/L;血ALB(白蛋白)<28 g/L;(6)肾脏:血Cr(肌酐)>123.8μmol/L,尿量<500 ml/24 h;(7)胃肠:肠鸣音减弱或消失,胃引流液、便潜血阳性或出现黑便、呕血,腹内压(膀胱内压)≥11 cm H2O(1 cm H2O=0.098 kPa).只要符合某器官中任意一个指标,即可判定该器官功能障碍.结论 通过本研究制定了MODS的诊断标准草案.本诊断标准草案具有一定的实用性,但还需通过临床应用积累经验而加以修正.