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目的总结小儿心脏手术后多脏器功能障碍综合征(MODS)病例的临床特点,探讨发生MODS患者中导致死亡的危险因素和防治措施。方法收集2001年1月至2010年12月本科先天性心脏病术后并发MODS患者35例,男21例,女14例;年龄(6.43±4.65)岁;体重(16.52±9.12)kg。将其中并发MODS的患者分为死亡组与存活组,进行比较,回顾性分析导致死亡的高危因素,总结脏器衰竭数目及MODS评分与病死率的关系。结果本组病死率为51.4%(18/35)。①受累器官的发生率依次为心脏100.0%(35/35)、肺脏80.0%(28/35)、肾脏60.0%(21/35)、肝脏14.3%(5/35)、血液系统11.4%(4/35)及中枢神经系统5.7%(2/35),其中心、肺出现受损的时间最早。②脏器衰竭数目在2、3、4、≥5个时对应的病死率分别是25.0%、45.5%、77.7%、100.0%;MODS评分与本组病死率亦呈显著正相关。③与存活患者相比,死亡患者体外循环时间、主动脉阻断时间明显延长,二次转机、围术期意外事件发生率显著增高(P<0.01)。结论心肺功能受损是导致小儿心脏术后MODS的原发病,MODS死亡率随脏器衰竭数目和MODS评分的增加而递增,死亡的高危因素为体外循环时间及二次转机、围术期意外事件,重在预防。
Objective To summarize the clinical features of multiple organ dysfunction syndrome (MODS) after pediatric cardiac surgery and to explore the risk factors leading to death in MODS patients and the prevention and treatment measures. Methods Thirty-five patients with MODS who underwent congenital heart disease complicated with congenital heart disease from January 2001 to December 2010 were collected. There were 21 males and 14 females with a mean age of 6.43 ± 4.65 and a weight of 16.52 ± 9.12 kg. The patients with MODS were divided into death group and survival group. The risk factors of death were retrospectively analyzed. The relationship between the number of organ failure and MODS score and mortality was retrospectively analyzed. Results The case fatality rate was 51.4% (18/35). ① The incidence of affected organs was 100.0% (35/35) in the heart, 80.0% (28/35) in the lung, 60.0% (21/35) in the kidney, 14.3% (5/35) in the liver, and 11.4% / 35) and central nervous system 5.7% (2/35), the earliest time of heart and lung damage. ② The number of organ failure in 2,3,4, ≥ 5, respectively, the corresponding mortality were 25.0%, 45.5%, 77.7%, 100.0%; MODS score was also significantly positive correlation with the case fatality rate. ③Compared with the surviving patients, the time of cardiopulmonary bypass and the aorta obstruction in patients died significantly prolonged, and the incidence of accidental events increased significantly (P <0.01). Conclusions Cardiopulmonary dysfunction is the primary disease causing MODS after pediatric cardiac surgery. Mortality rate of MODS increases with the number of organ failure and MODS score. The risk factors of death are extracorporeal circulation time, secondary transfer and perioperative accident Event, focus on prevention.