摘要
本文对51例TBSA>30％烧伤病人,其中17例并发MOF者进行了前瞻性研究。对烧伤后MOF的发生、发展规律进行了临床分析,对其发病的病理学基础进行探讨,对其早期诊断及诊断标准提出了新的见解。研究发现:烧伤后MOF大都发生于TBSA>70％的严重烧伤病人;其病死率与累及脏器的多少有关。肺功能衰竭发生率最高;肾功能衰竭死亡率最高。早发型MOF与休克关系密切;迟发型则主要因感染所致。内源性(肠源性及肺源性)感染参与了烧伤后MOF的发生和发展。衰竭脏器均有程度不同的细胞结构破坏、变性、坏死;细胞器损伤;脏器血管外水量增加,除肾脏外,主要脏器充血和/或瘀血,肾脏缺血。心肌酶谱、PaO_2、RI、IB/DB及DB的变化与相应脏器病理形态变化平行,基本能反映相应脏器损伤及功能衰竭程度。
Seventeen cases of postburn multiple organ failure (MOF) were studied prospectively.It was found that MOF mainly occurred in those patients with a burn area over 70% TBSA.Mortality rate of the cases of MOF was directly proportional to the number of organs involved.The incidence of pulmonary failure was the highest and the highest mortality was attributed to renal failure;MOF in the early stage after burns was mainly induced by burn shock and that in the late stage by burn wound infection.Endogenous infection seemed to be one of the important causes to precipitate the outbreak of postburn MOF.The morphological changes of the functionally failed organs were as follows:There were various degrees of cellular degeneration and necrosis.Or- ganelle changes such as swelling and vacuolization of mitochondria,enlargement of endoplasmic reticulum,gap formation of capillary endothelium etc were seen.Extravascular organ water volume of the functionally failed organs was increased.Stasis and/or hyperemia were found in the heart,the lungs,the liver and the GI,tract,but ischemia in the kidneys.The changes of the.enzyme spectrum of the myocardium,PaO2,RI,IB/DB,and DB were parallel to those of pathomorphology and extravascular organ water volume and they could reflect the severity of organ damages firly well.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
1991年第6期525-529,共5页
Journal of Third Military Medical University
关键词
烧伤
多器官衰竭
病理学
multiple organ failure
burns
burns/PP
burns/PA
respiratory insufficiency
kidney failure, acute
shock, traumatic
