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本文作者按照 Fry(1988年)的诊断标准,并参考张时纯所修正的标准,回顾性总结了近五年收治并行手术,治疗较系统的胆石症术后合并 MSOF 21例;全组病例均于术后1～7天,平均2天发生 MSOF;并都伴有不同程度休克,受累器官顺序依次肺、肝、肾、心脏及消化道。发生二衰者15例.病死率40%(死亡6例)二衰者6例,病死率83.3%(死亡5例)。作者以休克致 MSOF 的发生机制,引用单相速发型的概念,分析了本组大多数属于此类型。重点谈了黄疽与肝衰、肾衰的关系;认为梗阻性黄疽病人术后急性肾衰发生率与黄疽程度有密切关系,主张术前、术后尽量设法控制胆质血症。使胆红素降至4.0mg/dL 以下,可降低肾衰的发病率及死亡率。在 MSOF 教治中,主张积极抗休克,大剂量保肝药物应用,同时扩张肾血管,对 ARDS 病人争取早期气管切开。并认为由胆道感染和低血压所致心肌缺血及心律失常的病人及一些术前心动不全的老年人术后可能会发生心衰,故主张除一般强心措施外,重在早期认识和预防。
In accordance with the diagnostic criteria of Fry (1988) and with reference to the standard revised by Zhang Shimin, the authors retrospectively reviewed 21 cases of MSOF complicated with cholelithiasis treated with concurrent surgery in the past five years. All patients underwent surgery After 1 to 7 days, an average of 2 days MSOF; and are accompanied by varying degrees of shock, affected organs in order lung, liver, kidney, heart and digestive tract. There were 15 cases of the second decay.Case death rate was 40% (6 cases of death), 6 cases of second decay, the mortality rate was 83.3% (5 died). Based on the mechanism of shock-induced MSOF, the author quoted the concept of single-phase quick hairstyle and analyzed that most of this group belong to this category. Focus on the relationship between jaundice and liver failure, renal failure; that obstructive jaundice postoperative acute renal failure incidence and jaundice degree are closely related, advocating preoperative and postoperative try to control the choleraemia. Bilirubin to 4.0mg / dL below, can reduce the incidence of renal failure and mortality. In the MSOF teaching, advocating active anti-shock, high-dose hepatoprotective drugs, while expanding renal blood vessels, for ARDS patients for early tracheotomy. And that due to biliary tract infection and hypotension caused by myocardial ischemia and arrhythmia patients and some preoperative heart failure in elderly patients may occur after heart failure, it is advocated in addition to the general cardiac measures, focusing on early recognition and prevention .