危重病患者全身炎症反应综合征和多器官功能障碍综合征

Systemic inflammatory response syndrome and multiple organ dysfunction syndrome in critical patients

目的 提高对危重病患者发生全身炎症反应综合征 (SIRS)和多器官功能障碍综合征 (MODS)的认识。方法 分析 2 89例SIRS患者的临床资料 ,病人至少符合 2个SIRS标准 ,包括发热、体温过低、心动过速、呼吸急促或白细胞计数异常 ;MODS则符合各器官功能标准 ,而且在机体遭受打击 2 4小时后序贯出现两个或两个以上器官功能不全。结果 符合SIRS的危重病患者 2 89例 ,其中符合 2项标准者 75例 (2 5 9% ) ,3项者 10 4例 (36 0 % ) ,4项者 110例 (38 1% )。SIRS发展为MODS者2 0 3例 (70 2 % ) ,其中SIRS 2项者 5 4例 (2 6 6 % ) ,3项者 78例 (38 4% ) ,4项者 71例 (35 0 % )。死亡 15 0例 (73 9% ) ,其中SIRS2项者 38例 (2 5 3% ) ,3项者 5 9例 (39 3% ) ,4项者 5 3例 (35 3% ) ;二脏衰死亡 2 6例 (42 6 % ) ,三脏衰死亡 5 0例 (74 6 % ) ,四脏衰死亡 41例 (95 3% ) ,≥五脏衰死亡 33例 (10 0 0 % )。结论 SIRS可由细菌感染或非感染性疾病引起 ,且均能导致MODS ,阻断前炎症细胞因子和肿瘤坏死因子 -a的效应 ,对SIRS的发生有预防价值 ,可望降低MODS的发生。

Objective To study the significance of the occurrence and the development of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) in critical patients.Methods The clinical data of 289 patients with SIRS were analyzed.The patients met at least two of the criteria for SIRS such as fever,hypothermia,tachycardia,tachypnea of abnormal white blood cell count,while MODS accorded with the criteria for functional disorders of all organs and in 24 hours after the body was injured,more than two organs showed functional disorder in succession.Results In the 289 cases,those who met two,three or four of the criteria for SIRS were respectively 75(25.9%),104(36.0%) and 110(38.1%);203 patients (70.2%) progressed pour SIRS to MODS,among whom 54(26.6%),78(38.4%) and 71(35.0%) respectively were patients with two ,three and four of the criteria for SIRS,150 patients (51.9%) died,among whom 38(25.3%),59(39.3%) and 53(35.3%) respectively were patients with two,three and four of the criteria for SIRS.In the cases with MODS,26(42.6%),50(74.6%),41(95.3%) and 33(100.0%) patients respectively died of two,three,four,five and more than five internal organ failure.Conclusions SIRS might be caused by bacterial infection or noninfection diseases and both might cause MODS.Checking the effect of the proinflammatory cytokines and tumor necrosis factor might prevent the occurrence of SIRS and reduce the occurrence of MODS. [