[摘要] 目的 探讨心脏外科术后出现多脏器功能不全综合征（MODS）患者的血浆肿瘤坏死因子水平的变化、预后及影响预后的因素。方法 分析我院心脏外科2005年1月至2008年12月期间术后出现多脏器功能不全患者的临床资料，同时检测患者血浆肿瘤坏死因子水平及进行急性生理和慢性健康评估(acute physiology and chronic health evaluation,APACHEⅡ)。对照组为非多脏器功能不全患者，比较两组患者血浆肿瘤坏死因子水平、APACHEⅡ评分、预后及影响患者预后的危险因素。结果 我院四年来心脏外科术后出现多脏器功能不全患者51例，与对照组相比，MODS患者血浆TNF水平、APACHEⅡ评分、住院时间、住ICU时间、机械通气时间、肺部感染、血液系统感染、使用体外膜肺、使用主动脉内球囊反博存在统计学差异。Logistic回归分析多脏器功能不全患者死亡危险因素与体外膜肺氧合（ECMO）治疗、术前直接胆红素、术前Bun、术前血肌酐、住ICU时间、血浆肿瘤坏死因子水平、APACHEⅡ评分、术后住院时间有关。结论心脏手术后MODS患者全身炎性反应增强，预后较差。

 [关键词] 多脏器功能不全综合征；血浆肿瘤坏死因子水平；预后；心脏外科手术后

[Abstract]  Objective To investigate the prognosis and risk factors with multiple organ dysfunction syndrome(MODS) and to evaluate the significance of the prediction of APACHEⅡscoring system and  TNF-α for hospital patients in ICU after cardiac surgery. Methods The clinical data of patients with MODS and non-MODS in our hospital from January 2005 to December 2008 were studied retrospectively. Result  There were 51 patients of MODS during the study period after cardiac surgery. The overall mortality rate was 54.9%, the Logistic regression analysis revealed that Extracorporeal Membrane Oxygenation(ECMO) therapy, direct bilirubin before surgeon, blood urea nitrogen before surgeon, blood creatinine before surgeon,length of stay in ICU, length of stay after operation , APACHEⅡscore and TNF-α were the related risk factors of prognosis. Conclusion MODS was a severe complication after cardiac surgery , patients with MODS haveinflammatory response. The prognosis is not better.

   [Key words] Multiple organ dysfunction syndrome; TNF; Prognosis; Postoperation of cardiac surgery