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目的分析老年脑出血昏迷患者继发多器官功能障碍综合征(MODS)的相关影响因素,为有效防治老年脑出血昏迷患者继发MODS提供参考。方法采取前瞻性研究方法选择2013年1月至2014年12月收治的78例老年脑出血昏迷患者作为研究对象。入院后即行格拉斯哥昏迷评分(GCS),入院后24 h内进行急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评定,检测血清白细胞介素(IL)-1、IL-6、IL-10、C反应蛋白(CRP)、白蛋白、血糖水平,入院第1天开始监测患者MODS发生情况。采用t检验对MODS发生的危险因素进行单因素分析,采用多因素Logistic回归法分析MODS的独立危险因素。结果 78例患者中31例(39.74%)出现MODS,31例中死亡15例,多为3个及以上器官衰竭患者。单因素分析显示,血糖、IL-1、IL-10、CRP水平、APACHEⅡ评分、脑出血体积、GCS评分、血清白蛋白水平是老年脑出血昏迷患者发生MODS的影响因素(P<0.05,P<0.01)。多因素Logistic回归分析结果显示,APACHEⅡ评分高、脑出血体积大、血糖、IL-1、IL-10水平高及血清白蛋白水平低是老年脑出血昏迷患者继发MODS的独立危险因素(P<0.05,P<0.01)。结论炎症反应、血糖水平、脑出血体积、APACHEⅡ评分、营养状况与老年脑出血昏迷患者继发MODS密切相关,要改善患者全身状况,有效控制血糖水平,以减少MODS的发生。
Objective To analyze the influencing factors of multiple organ dysfunction syndrome (MODS) in patients with cerebral hemorrhage coma and to provide a reference for the effective prevention and treatment of secondary MODS in patients with cerebral hemorrhage coma. Methods A prospective study was conducted to select 78 patients with cerebral hemorrhage coma in our hospital from January 2013 to December 2014. Glasgow Coma Scale (GCS) was admitted after admission, and acute physiology and chronic health status score (APACHEⅡ) were assessed within 24 hours after admission. Serum interleukin (IL) -1, IL-6, IL- Protein (CRP), albumin, blood glucose levels, the first day of admission began to monitor the occurrence of MODS in patients with. The t-test was used to analyze the risk factors of MODS by univariate analysis and multivariate logistic regression analysis was used to analyze the independent risk factors of MODS. Results Of the 78 patients, MODS occurred in 31 patients (39.74%), and 15 patients died in 31 patients, mostly in 3 or more patients with organ failure. Univariate analysis showed that the levels of blood glucose, IL-1, IL-10 and CRP, APACHEⅡscore, volume of cerebral hemorrhage, GCS and serum albumin were the influencing factors of MODS in patients with cerebral hemorrhagic coma (P <0.05, P < 0.01). Multivariate logistic regression analysis showed that high APACHEⅡscore, large volume of cerebral hemorrhage, high blood glucose, high level of IL-1, IL-10 and low level of serum albumin were independent risk factors of MODS secondary to cerebral hemorrhagic coma (P < 0.05, P <0.01). Conclusions Inflammatory reaction, blood glucose level, volume of cerebral hemorrhage, APACHEⅡscore and nutritional status are closely related to secondary MODS in patients with cerebral hemorrhage and coma. To improve the general condition of patients and control blood sugar level effectively to reduce the incidence of MODS.