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目的探讨老年急腹症合并感染性休克患者的临床特点及外科治疗。方法回顾性分析75例老年急腹症合并感染性休克患者的临床资料。结果老年急腹症合并感染性休克患者发病率高,早期诊断困难,且多伴有其他慢性疾病,病情复杂,死亡率高。其原发病多为急性梗阻性化脓性胆管炎(AOSC),本组病例经紧急抗休克治疗后,手术治疗59例,治愈41例(69.5%);非手术治疗16例,治愈5例(31.2%),两组治疗治愈率差异有显著性(P<0.05)。本组75例患者病死率为38.7%(29/75),主要死亡原因为多脏器功能障碍综合征(MODS),占58.6%(17/29)。治疗中并发急性呼吸窘迫综合征(ARDS)和急性肾功能衰竭比较常见,发生率分别为36%(27/75)和32%(24/75)。结论老年急腹症合并感染性休克的治疗对策应首先积极抗休克治疗保持血流动力学稳定,同时选择合适的时机及时手术,注意控制感染并早期防治MODS,以上措施的综合运用可以明显提高治愈率。
Objective To investigate the clinical features and surgical treatment of senile acute abdomen with septic shock. Methods A retrospective analysis of 75 cases of senile acute abdomen with septic shock in patients with clinical data. Results Senile acute abdomen with septic shock patients with high incidence, early diagnosis difficult, and often accompanied by other chronic diseases, the condition is complicated, the mortality rate is high. The primary disease mostly acute obstructive suppurative cholangitis (AOSC), the group of patients after emergency anti-shock treatment, surgical treatment of 59 cases, 41 cases were cured (69.5%); non-surgical treatment of 16 cases, 5 cases were cured 31.2%), the difference between the two groups was significant (P <0.05). The mortality of 75 patients was 38.7% (29/75). The main cause of death was multiple organ dysfunction syndrome (MODS), accounting for 58.6% (17/29). Treatment of acute respiratory distress syndrome (ARDS) and acute renal failure are more common, the incidence was 36% (27/75) and 32% (24/75). Conclusion The treatment of senile acute abdomen with septic shock should be active and anti-shock treatment to maintain hemodynamic stability, and select the appropriate timing and timely surgery, attention to infection control and early prevention and treatment of MODS, the comprehensive utilization of these measures can significantly improve the cure rate.