全身炎症反应综合征的靶器官保护

Target organ protected strategy on systemic inflammatory response syndrome

目的探讨全身炎症反应综合征（SIRS）的治疗方法。方法阳江市人民医院重症监护室2004年2月至2006年12月收治的SIRS患者108例随机分为两组，对照组（n=58例）按常规治疗，治疗组（n=50例）为保护炎症靶器官（肠道、肺脏、胰腺）加以下的治疗：①生大黄30g，水煎成200ml溶液，每13分2次口服或管饲。②盐酸氨溴索60mg，ivgtt，Bid。③乌司他丁40万U，iv，q8h。疗程5d。监测外周血白细胞（WBC）、高敏C反应蛋白（ks-CRP）、血清淀粉酶（AMY）．氧合指数（PaO2／FiO2）的变化。统计学方法采用x^2检验、配对t检验和方差分析。结果两组治疗前各项监测指标差异无统计学意义（P〉0．05），治疗组hs-CRP、AMY均于治疗后第3天明显下降，WBC于治疗后第5天明显下降，PaO2／FiO2于治疗后第5天明显增加，各项指标的改善均优于对照组（P〈0．05或P〈0．01）。治疗组多器官功能障碍综合征（MODS）发生率降低（46．0％vs65．5％，P〈0．05），病死率降低但无统计学意义（42．0％vs56．9％，P〉0．05）。结论注重炎症靶器官保护可降低SIRS患者的MODS发生率。

Objective To explore the therapreutic approach to systemic inflammatory response syndrome （SIRS）. Method One hundred and eight patients with SIRS form February 2004 through December 2006 in ICU of Yangjiang people＇ s hospital were randomly divided into treatment group （ n = 50） and control group （ n = 58）. Both groups were given routine treatment, while those in the treatment group were given decocturn of Rhubarb 30 g, orally twice a day; Ambroxol HCL 60 rag, iv gtt, Bid and Ulinastatin （400 000 U, iv, Q8h, for 5 days for addition in order to protected organ included intestine, lungs and pancreas. White blood cell （WBC）, high sensitive C-reactive protein （hs-CRP）, amylase （AMY）, PaO2/FiO2 were monitored during the course of pharmacological intervention. 7.2 test t, test and variance analysis were used for the statistical study. Results All the monitored indexes had no significant difference between two group before treatment. In the treatment group hs- CRP, AMY were significantly reduced at the 3rd day, WBC was significantly lowed at the 5th day; and PaO2/ FiO2 increased significantly at the 5th day after pharmacological intervention. All the monitor bio-markers were improved better than those in the control group （ P 〈 0.05 or P 〈 0.01 ）. The incidence of MODS was significantly lower in the treatment group （ 46.0% vs 65.5%, P 〈 0.05）, but the mortally between two groups was no difference at statistics （42.0% vs 56.9%, P 〉 0.05）. Conclusions Intensive protected of target organ against SIRS by Rhubarb, Ambroxol Hcl and Ulinastain could reduced the incidence rate of MODS in patients with SIRS.