The Clinical Analysis Of 20 Patients With MODS Caused By Severe Community Acquired Pneumonia

Objective: The aim of this study was to investigate the clinical characteristics,the risk factors related to death, the diagnosis and therapy of the Multiple organ dysfunction system(MODS)caused by Severe community acquired pneumonia(SCAP) .Methods: Summarized the 20 patients with MODS caused by SCAP, who were diagnosed by the First Affiliated Hospital of Dalian Medical University from 2005-2010.Results:1.The situation of foundation disease: 6 cases of COPD, 4 cases of hypertension, 3 cases of atrial fibrillation, 3 cases of stroke, 2 cases of cancer, 2 cases of diabetes mellitus, 1 case of asthma, 1 case of coronary heart disease, 1 case of psoriasis, 3 cases of long time in bed(≥3months), 6 cases of healthy.2.Clinical symptoms and signs: 17 cases of fever(T38.7-40.7℃),13 cases of cough and expectoration, 7 cases of dyspnea,3 cases of blood phlegm,2 cases of chest pain,3 cases of disturbance of consciousness,3 cases of vomiting and diarrhea,9 cases of R≥30/min,5 cases of P≥120/min, 5 cases of Bp<90/60mmHg, 3 cases of T≥40℃, Lung auscultation can find positive signs. The positive signs include rhonchus, crackles, abnormal bronchial breathing sounds, weakening of alveolus respiratory sounds.3.The characteristic of X-Ray: 3 cases of pathological changing on left lung, 4 cases of pathological changing on right lung, 13 cases of pathological changed on both lungs, 10 cases of pleural effusion. The CT revealed high density shadow, inflammatory exudation shadow, or consolidation shadow. We not found the tumescent mediastinal lymph nodes and the tumescent hilar lymph nodes.4.The clinical laboratory testing: blood routine test:7cases of WBC>20×10⁹/L,3 cases of WBC<4×10⁹/L(or)N<1×10⁹/L, 15 cases of PaO₂<60mmHg when they breathed air, 18 cases of PaO₂/FiO₂≤200,3 cases of PaCO₂>50mmHg, 9 cases of Cre>176.8μmol/L, 4 cases of HB<90g/L, 9cased of ALT>80U/L, 9 cases of STB>34.2μmol/L, 9 cases of ALB<30g/L, 5 cases of FPG>7.0mmol/L(except the patients who had the medical history of DM), 7 cases of PLT<100×109/L or progressive decline , 5 cases of PT>or<3s, 5 cases of APTT>or<10s, 5 cases of Fib<1.5g/L or progressive decline or Fib>5 g/L, 6 cases of D-dimer>500ug/L, 9 cases of electrolytes disturbance. The positive of the sputum culture was 55%, the main bacterium are Pseudomonas aeruginosa, Klebsiella pneumoniae, Bacillus coli, and Baumanii.5.The situation of failure organs: lung is the first failure organ in 18 cases of patients;19 cases of patients happened lung failure,14 case of patients happened renal failure, 10 cases of patients happened liver failure, 5 cases of patients happened heart failure, 5 cases of patients happened DIC, and the Corresponding mortality was 74%,86%,60%,80%,100%;9 cases of patients had two organs failure, 6 cases of patients had three organs failure , 6 cases of patients had more than three organs failure, and the Corresponding mortality was 44.4%,83.3%,100%.6.The treatment: We gave antibiotic to all the patients basis on experience before we got the results of the sputum germiculture. We gave hormone to 7 patients(40-160mg/d qd-bid ivgtt). We gave Antifungal drugs to 7 patients. 5 patients occurred DIC, so we gave them heparin. We gave immune adjustment treatment to 3 people.16 patients should give Mechanical ventilation, but 2 patients refused .1 patient was given hemofiltration. 1 patient was given lavage by bronchoscope. We gave nutrition support to all the patients.7.The prognosis: 14 patients died, the mortality was 70%; 14 cases of patients were given Mechanical ventilation, 12 patients died, the mortality was 85.7%. Conclusion: Lung is the first failure organ in MODS. Prevention of pulmonary infection may play a key role in the reduction of morbidity and mortality of MODS. The patients, who were eld, had foundation disease, happened renal failure, had higher mortality. The mortality of more than three organs happened failure approached 100%.