抗生素与H2受体拮抗剂联用对外科手术患者全身炎症反应综合征发病率和预后的影响

目的探讨外科手术后联合应用抗生素及H2受体拮抗剂对患者SIRS发病率及预后的影响.方法回顾性地对4年半余本院外科手术后患者未用、单纯应用和伍用抗生素和/或H2受体拮抗剂后的SIRS发病率及预后进行临床分析.结果单纯应用抗生素或H2受体拮抗剂的患者SIRS发病率较未用组患者明显降低;抗生素和H2受体拮抗剂联用的患者较未用组和单纯应用组SIRS发病率显著降低;单纯应用抗生素或H2受体拮抗剂组间比较SIRS发病率无显著差异;各组SIRS发生后病死率无显著差异.结论外科手术后患者联合应用抗生素和H2受体拮抗剂可以明显减少SIRS的发病率,但对SIRS发生后患者的病死率影响较小.     

全身炎症反应综合征

本文介绍了全身炎症反应综合征的病理生理学和参与发病机制的介质(包括继发性介质)的作用。     

全身炎症反应综合征对重症急性胰腺炎预后的影响

目的: 了解重症急性胰腺炎（SAP）时全身炎症反应综合征（SIRS）的发生及其对预后的影响 。方法: 对37例SAP患者进行回顾分析,按治疗结果分为治愈组和死亡组,分别对SIRS标准、脏器受损情况及预后进行观察 。结果: 28例治愈（治愈组）,9例死亡（死亡组）。治愈组符合SIRS标准者23例（23/28）,其中符合3项以上者6例（6/28）,死亡组全部病例均符合SIRS诊断标准,其中符合3项以上标准者7例（7/9）。两组间统计,P<0.005。多器官功能障碍发生情况：治愈组4例（4/28）,死亡组9例（9/9）,P<0.005。SAP时SIRS的发生率较高,本组为84.21%（32/37） 。结论: 多器官功能障碍综合征（MODS）的发生随达到SIRS标准项目数的增加而大大增加,病死率也随之增高。     

全身炎症反应综合征和多器官功能障碍综合征

感染与外科形影相随,脓毒症（有人译作全身性感染）和脓毒性休克从来都是外科的棘手问题,由其引发的多器官功能衰竭（ＭＯＦ）更是外科危重病人的主要死因之一。传统的观念注重于细菌或其毒素的直接作用,但临床发现,非感染性疾病如严重创伤、大手术、急性胰腺炎,也同...     

异丙酚对创伤后全身炎症反应综合征患者炎性细胞因子的影响

目的：研究异丙酚对合并全身性炎症反应综合征（SIRS）的骨科创伤患者炎性细胞因子的影响。方法：将40例合并SIRS、麻醉前创伤评分≤13分、手术时间4h以内、估计累计出血量≥1000ml的骨科创伤患者随机分为两组（n=20）,两组均行切开复位内固定术,均采用静吸复合麻醉,全麻诱导方式相同,对照组给予依托咪酯0．2～0．3mg／kg静脉注射,异丙酚组给予异丙酚1．O～2．0mg／kg静脉注射,并术中维持,其余处理方法相同。分别于全麻诱导前、麻醉后5min、术毕、术后1d和7d检测血浆白细胞介素-1β（IL-1β）、IL-6、IL-8、肿瘤坏死因子-α（TNF—α）含量。结果：两组患者麻醉前炎性细胞因子水平差异无显著性;各组于麻醉后5min与诱导前比较亦无明显变化;术毕及术后1d两组炎性细胞因子均升高,但异丙酚组升高幅度较小,相同时间点两组间IL-6、IL-8、TNF—α差异有显著性（Pd0．05）;术后7d两组炎性细胞因子水平差异无显著性（P〉O．05）。结论：异丙酚对SIRS患者炎性细胞因子生成具有抑制作用,能在一定程度上抵抗机体过度炎性反应。     

全身炎症反应与体外循环

体外循环（CPB）可使机体产生大量的炎症介质,引起全身炎症反应综合征（SIRS）,进一步发展导致多器官功能障碍综合征（MODS）,其发病机制目前较为公认的是“二次打击”学说。围体外循环期SIRS的预防和治疗策略很多,CPB装置的改进及减少炎症介质的生成是主要措施。随着对核转录因子NF-kB研究的不断深入,有可能从分子生物学水平调控CPB引发SIRS的程度。     

全身炎症反应综合征甲状腺激素水平的变化

外科严重感染是危重病人死亡的一个主要原因 ,治疗上除应用有效的抗生素外 ,还需阻断参与感染连锁反应的炎症介质和宿主细胞因子等作用。近 2 0年来 ,感染性疾病的治疗有了明显的进展 ,包括对抗感染和增强宿主防御功能及新的诊疗技术等手段 ,但外科严重感染的死亡率并未明显降低。外科严重感染常表现为菌血症、败血症、脓毒症、脓毒性休克、全身炎症反应综合征和多器官功能不全综合征 (ｍｕｌｔｉ ｐｌｅｏｒｇａｎｄｙｓｆｕｎｃｔｉｏｎｓｙｎｄｒｏｍｅ,ＭＯＤＳ)。文献报道 ,约 70 %的外科住院病人尤其是伴全身炎症反应综合征的病人存在…     

IL-1O与全身炎症反应综合征

白细胞介素10(IL-10)是一种作用广泛的抗炎细胞因子,在体内炎症反应的调控上发挥着重要的作用.全面深入研究IL-10的功能、产生、调控、抗炎和免疫抑制作用机制,可为最终解决全身炎症反应综合征这一临床难题的探索提供新思路.     

对“全身炎症反应综合征”命名的异议

“全身炎症反应综合征”的命名已引起临床方面的重视，但经的概念仍不完全清楚。其划定的定义范围比较敏感，未能说明其病理生理学特点，对临床应用的帮助不大。     

IL-10与全身炎症反应综合征

白细胞介素10(IL-10)是一种作用广泛的抗炎细胞因子,在体内炎症反应的调控上发挥着重要的作用。全面深入研究IL-10的功能、产生、调控、抗炎和免疫抑制作用机制,可为最终解决全身炎症反应综合征这一临床难题的探索提供新思路。     

The significance of the systemic inflammatory response syndrome (SIRS) in 1278 trauma patients

Summary The association between the increasing severity of systemic inflammatory response syndrome (SIRS) and the incidence of posttraumatic complications and mortality was retrospectively investigated in 1278 injured patients. Patients were divided into three groups according to their Injury Severity Score (ISS) (group A: ISS L 9 K16 points (n = 626); group B: ISS > 16 < 40 points (n = 589); group C: ISS L 40 points (n = 63)). SIRS was defined according to the criteria of the American Consensus Conference. The number of fulfilled criteria determined its severity: moderate SIRS: 2 criteria fulfilled, intermediate SIRS: 3 criteria fulfilled, severe SIRS: 4 criteria fulfilled. Additionally, acute respiratory distress syndrome (ARDS) was defined according to the Murray-Score and the multiple organ dysfunction syndrome (MODS) according to the Goris-Score. The incidence of SIRS was 42 % in group A, 70 % in group B and 100 % in group C (p < 0.05). The severity of SIRS increased with severity of trauma. Moreover, 178 of all injured patients (14 %) developed septic complications. In parallel to SIRS, the incidence of these septic complications correlated with the severity of trauma. The occurrence and severity of ARDS and MODS correlated with increased severity of SIRS and septic complications. Among patients without SIRS 15 % developed ARDS and 21 % MODS. In contrast, patients with severe SIRS and septic complications demonstrated ARDS in 99 % and MODS in 97 %. In these patients, no correlation was found between the ISS and the incidence of ARDS or MODS. There were also stepwise increases in mortality rates in the hierarchy from SIRS to septic shock. While 13 of patients with modest SIRS (5 %) and 32 of patients with intermediate SIRS (13 %) died, the mortality rate of patients with severe SIRS was 19 % (p < 0.05). In addition, a significant correlation between the incidence of septic complications and mortality was found. Injured patients with sepsis died in 13 %, those with severe sepsis in 23 %, and patients with septic shock in 33 % (p < 0.05). Thus, the increasing severity of SIRS was associated with the occurrence of posttraumatic ARDS, MODS, and mortality. Using the number of fulfilled SIRS criteria for classifying systemic inflammation, its severity may be predictive for posttraumatic complications and outcome of injured patients.      

Clinical evaluation of systemic inflammatory response syndrome (SIRS) in advanced lung cancer (T3 and T4) with surgical resection.

OBJECTIVES: The systemic inflammatory response syndrome (SIRS) is well known to occur in patients who have suffered organ damage or trauma, or undergone surgery. SIRS provides useful information in patients with morbidity after surgery. To date, there has been no report of SIRS after surgery in patients with lung cancer. Therefore, based on this new concept of the syndrome, we review here a series of T3 and T4 NSCLC patients who underwent extended resection at our hospital, and attempt to identify the value and correlation of SIRS in predicting the morbidity of such patients. METHODS: We retrospectively reviewed the patients with NSCLC treated at our hospital between January 1994 and August 2003. Among these 720 patients, a curative approach was attempted in 144 with advanced stage (T3, 100; T4, 44) cancer. The patients were consequently divided into three groups (G1, negative or less than 3 days in SIRS following surgery; G2, less than 7 days; G3, continued over 7 days). Pre- or peri-operative factors were evaluated, and the 5-year survival rates were analyzed. Post-operative morbidity was also compared between the three groups in association with SIRS. RESULTS: Pre-operative counts of WBC were 8848.28+/-3879.21/microl in G3 compared with 7383.33+/-3132.98/microl in G2 and 6778.31+/-3184.89/microl in G1. Values in G3 were significantly higher than those in the other groups (P<0.001). Predicted %FEV1 in G3 was significantly lower than those in the other groups. Duration of SIRS after lung surgery was associated with high levels in WBC and low %FEV1. Post-operative morbidity such as bronchial fistula or ARDS were more frequent in the G3 and G2 groups than in G1. The 1-year survival was as follows; G1, 75.4%; G2, 47.9%; G3, 38.1%. Overall 5-year survival rate for NSCLC with T3 and T4 was 32.2%, and the difference between G3 and the other groups in terms of survival was statistically significant (P<0.0001). CONCLUSIONS: The concept of SIRS have been associated with post-operative complications and survival in NSCLC. Surgical candidates should be carefully according to the predicting factor of SIRS.     

绞窄性肠梗阻与全身炎性反应综合征相关性分析

目的探讨绞窄性肠梗阻与全身炎性反应综合征(SIRS)的关系。方法回顾性分析42例肠梗阻手术病人的临床资料。结果SIRS诊断绞窄性肠梗阻的敏感性为81.8%;特异性为85%。SIRS判断肠坏死的敏感性为95.2%;特异性为76.2%。绞窄性肠梗阻患者的白细胞明显高于单纯肠梗阻[(12.3±3.6)×109/L对(8.5±3.6)×109/L,P=0.242],心率也明显升高[(106.1±21.2)次/分对(82.3±15.1)次/分,P=0.0137]。肠坏死者的白细胞明显高于无肠坏死者[(13.4±2.9)×109/L对(9.0±2.0)×109/L,P=0.0162]。SIRS阳性者坏死肠段明显长于SIRS阴性者[(86.24±22.3)cm对5.8cm,P=0.0049]。结论SIRS能够提示肠梗阻出现肠绞窄。     

Methylene blue administration in severe systemic inflammatory response syndrome (SIRS) after thoracic surgery.

A 66-year-old male patient developed significant pleural effusion on the right side six years after coronary bypass grafting and mitral valve replacement. After pleurocentesis, hemo-pneumothorax developed and finally resulted in complete atelectasis of the right lung. Three weeks later, the patient was transferred to our department, and underwent a right lateral thoracotomy. The hematoma was removed and a complete decortication was performed. Four hours postoperatively the patient developed severe SIRS with beginning multiorgan failure. Even extremely high doses of norepinephrine could not raise the systemic vascular resistance. Single intravenous administration of methylene blue lead to significant and permanent improvement of the hemodynamic status.     

The clinical value of the systemic inflammatory response syndrome (SIRS) in abdominal aortic aneurysm repair.

OBJECTIVES: The systemic inflammatory response syndrome (SIRS) is common after major surgery. We examine the dynamics of SIRS in AAA patients, and assess the impact of the number of SIRS criteria on patient outcome. DESIGN: Prospective study of 151 consecutive patients with AAA, undergoing repair electively, urgently or with rupture. METHODS: SIRS scores and organ failure scores were recorded prospectively each day for all patients. Outcome measures included length of stay, evidence of organ failure and mortality. RESULTS: The majority of patients developed SIRS postoperatively. Elective patients with a cumulative SIRS score of > or =10 during postoperative days 1-4 were more likely to die, compared to patients with a SIRS score of <10 (p=0.02). The development of SIRS late in the postoperative period (day 5-10) was associated with adverse outcome (death) in elective patients (p=0.01). The actual number of SIRS criteria present did not significantly correlate with either outcome or the incidence of organ failure. CONCLUSIONS: SIRS is common in patients undergoing AAA repair. The SIRS score provides useful information regarding a patient's physiological state. High SIRS scores, and the development of SIRS late in the postoperative period are associated with adverse outcome in elective patients, and can therefore be used as an indicator of potential problems.     

Systemic inflammatory response syndrome (SIRS) in serious chest injuries: is a pharmacological blockade effective?

PURPOSE: There has been an ongoing increase in the frequency and severity of blunt chest injuries. Their rather high lethality is caused by the injury alone as well as by the following systemic inflammatory response. The aim of the study is to verify the efficacy of the pharmacological blockade of the systemic inflammatory response syndrome (SIRS) in serious blunt chest injuries, and to identify whether the administration of indomethacin as a cyclooxygenase inhibitor could prevent a multiorgan dysfunction (MODS) and a multiorgan failure (MOF). METHODS: Patients were divided into 4 Groups according to trauma severity--injury severity score (ISS) and into two subgroups--an indomethacin subgroup where patients received indomethacin together with standard therapy, and a non-indomethacin subgroup. RESULTS: Eighty-four patients were included in the study and 33 patients were given indomethacin. In Groups III and IV there was a later increase in inflammatory markers in patients treated with indomethacin. The elevation of inflammatory markers and the period of mechanical ventilation support in patients treated with indomethacin were shorter in Groups II and III. Seven (8.3%) patients died. Six of the seven dead patients were from the non-indomethacin subgroup. MOF was the cause of death in two patients in the non-indomethacin subgroup and in one patient in the indomethacin subgroup. CONCLUSION: The results obtained during the first 20 months of the study imply that a certain number of patients with serious blunt chest trauma could benefit from indomethacin administration.     

Procalcitonin (PCT) in cardiac surgery: diagnostic value in systemic inflammatory response syndrome (SIRS), sepsis and after heart transplantation (HTX)

PURPOSE: Since it is of great importance to distinguish between a systemic inflammatory response syndrome (SIRS) and an infection caused by microbes especially after heart transplantation (HTX), we examined patients following heart surgery by determining procalcitonin (PCT), because PCT is said to be secreted only in patients with microbial infections. METHODS: Sixty patients undergoing coronary artery bypass grafting (CABG) and 14 patients after heart transplantation were included in this prospective study. In the CABG group we had 30 patients without any postoperative complications (group A). Furthermore we took samples of 30 patients who suffered postoperatively from a sepsis (group B, n=15) or a systemic inflammatory response syndrome (C, n=15). In addition we measured the PCT-levels in 65 blood samples of 14 patients after heart transplantation (Group I: rejection > IIa, II: viral infection (CMV), III: bacterial/fungal infection, IV: controls). RESULTS: In all patients of group A the pre- and intraoperative PCT-values and the measurement at arrival on intensive care unit (ICU) were less than 0.2 ng/ml. On the second postoperative day the PCT-value was 0.33+/-0.15 ng/ml in the control group. At the same time it was 19.6+/-6.2 ng/ml in sepsis and 0.7+/-0.4 ng/ml in systemic inflammatory response syndrome patients (P<0.05). In transplanted patients we could find the following PCT-values: Gr.I: 0.18+/-0.06 II: 0.30+/-0.09 III: 1.63+/-1.16 IV: 0.21+/-0.09 ng/ml (P<0.05 comparing group III with I, II and IV). CONCLUSIONS: These results show that extracorporeal circulation (ECC) and systemic inflammatory response syndrome do not initiate a PCT-secretion. Septic conditions cause a significant increase of PCT. In addition, PCT is a reliable indicator concerning the essential differentiation of bacterial or fungal--not viral--infection and rejection after heart transplantation.