重度创伤后全身炎症反应综合征和多器官功能障碍综合征

Clinical study on systemic inflammatory response syndrome and multiple organ dysfunction syndrome after severe trauma

目的 :提高对重度创伤后并发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 :分析了 35 5例 SIRS和 12 8例损伤严重度评分 (ISS) >16分的 MODS患者临床资料。患者应至少符合修订后2项或 2项以上 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则符合各器官功能障碍标准 ,而且符合机体遭受打击 2 4小时后序贯出现 2个或 2个以上器官功能不全。结果 :35 5例患者中符合修订后 SIRS 2项标准者 12 7例 (35 .8%) ,3项者 136例 (38.3%) ,4项者 92例 (2 5 .9%)。死亡 116例 (32 .7%) ,其中死于 MODS者 83例 (71.6 %)。符合 SIRS2项标准者死亡 12例 (9.4%) ,3项者死亡 2 3例 (16 .9%) ,4项者死亡48例 (5 2 .2 %) ,SIRS2、3项与 4项比较差异非常显著 (P均 <0 .0 1)。83例死亡的 MODS患者中 ,死于 2个脏器障碍者 16例 (34 .0 %) ,3个者 2 5例 (6 9.4%) ,4个者 30例 (90 .9%) ,≥ 5个者 12例全部死亡 (10 0 .0 %)。死于非MODS者 33例 (2 8.4%)。结论 :重度创伤后 ,创伤后休克、感染及创伤后免疫功能障碍均可引发 SIRS,严重者可导致 MODS,代偿性抗炎反应综合征。

Objective:To study the significance of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) after severe trauma.Methods:The clinical data of 335 SIRS cases and 128 MODS cases were analyzed.The injury severity scores (ISS) in all cases were exceeding 16.The patients of SIRS met at least two or more of the revised criteria for SIRS,including fever,hypothermia,tachypnea or abnormal white blood cell count.In addition,those of MODS met the criteria of multiple organ dysfunction and the sequential occurrence of functional insufficiency in two or more organs 24 hours after trauma.Results:Among the 355 cases,those who met two,three and four of the revised criteria for SIRS were 127 (35 8%),136 (38 3%) and 92 (25 9%) cases respectively.116 out of 335 patients (32 7%) died,among which 83 died of MODS (71 6%),including 12 (9 4%) who met two of criteria for SIRS,23 (16 9%) met three and 48 (52 2%) met four.Notable discrepancy existed between those who met two or three SIRS criteria and those who met four (all P <0 01).Within the 83 patients who died of MODS,16 (34 0%) died of dysfunction in two organs,25 (69 4%) in three organs,30 (90 9%) in four organs,and 12 (100 0%) in five or more.The other 33 (28 4%) died not of MODS.Conclusions:It is suggested that severe posttraumatic shock,infection and immunologic dysfunction might cause SIRS or even MODS,and compensatory antiinflammatory response syndrome (CARS) and mixed antagonistic response syndrome (MARS) might play an important role in the maintenance of the equilibrium of internal environment of the body.