重视全身炎症反应综合征的研究

全身炎症反应综合征（ｓｙｓｔｅｍｉｃｉｎｆｌａｍｍａｔｏｒｙｒｅｓｐｏｎｓｅｓｙｎｄｒｏｍｅ,ＳＩＲＳ）是感染或非感染因素刺激宿主免疫系统,释放体液和细胞介质,发生炎症过度反应的结果［１］。ＳＩＲＳ继续发展,对血管张力和渗透性产生影响,导致循环障碍,...     

降钙素原与全身炎症反应综合征

全身炎症反应综合征(systemicinflammatoryresponsesyn-drome,SIRS)是指机体自身失去控制的,持续放大和自我破坏的炎症反应,表现为播散性炎细胞活化、炎症介质溢出到血浆并由此引发远隔部位的炎症反应。根据1991的定义[1]诊断标准,符合下列临床表现者即可诊断为SIRS:(1)体温>38     

肝硬化合并全身炎症反应综合征临床分析

目的：了解全身炎症反应综合征（SIRS）在肝硬化患者中的发生率及其对病情的影响。方法采用回顾性分析法分析180例肝硬化患者SIRS的发生率与肝功能Child-Pugh分级的关系,并在12周、24周、48周时观察两组累计慢性肝衰竭的发生率和累计死亡率。结果180例患者肝功能Child-Pugh分级A级128例、B级27例、C级25例,发生SIRS的比例分别是23．4％（30/128）、51．9％（14/27）、64．0％（16/25）。共有60例并发SIRS,总发病率33．3％。48周内累计慢性肝衰竭发生例数SIRS组共20例（33．3％）,非SIRS组共8例（6．7％）。48周内SIRS组死亡16例,累计死亡率26．7％（16/60）,非SIRS组死亡2例,累计死亡率1．7％（2/120）。结论肝硬化患者合并SIRS可进一步加重肝损害,累计慢性肝衰竭的发生率和累计死亡率均显著升高。     

全身炎症反应综合征1 292例临床分析

目的 提高对危重病人发生全身炎症反应综合征（ＳＩＲＳ）的认识。方法 分析１２９２例ＳＩＲＳ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。结果 １２９２例患者中细菌学检查３４１例（２６．４％）,其中阳性者１３８例（４０．５％）,死亡３３例（２３．９％）。１２９２例患者中符合ＳＩＲＳ２项标准者４６７例（３６．１％）,３项者５２６例（４０．７％）,４项     

脑梗死后全身炎症反应综合征的研究

目的 探讨急性脑梗死后全身炎症反应综合征(SIRS)及相关临床因素与预后的关系.方法 采用前瞻性试验设计,对500例急性脑梗死患者进行SIRS及各相关因素调杏,并行单因素分析和Cox回归生存分析.结果 500例脑梗夕匕患者中SIRS 85例,其中完全前循环发生SIRS 31例;部分前循环34例,后循环15例;腔隙性梗死5例.脑梗死患者出现发热后,不同类型腑梗死SIRS发生率与病死率有较强的一致性(Spearman 1.0,P＜0.001).单因素分析年龄、感染、48h神经功能缺损评分,48h Glassgow评分、牛津郡社区卒中计划(OCSP)、吞咽困难、糖尿病为SIRS危险因素;SIRS为脑梗死后21d病死率的危险因素.Cox回归分析显爪脑梗死预后的独立危险凶素为48h Glassgow评分,SIRS人选方程,但P值＞0.05.结论 急怀性脑梗死后SIRS及其相关危险因素与脑梗死21d内病死率显著相关,糖尿病脑梗死患者SIRS发牛率高.脑梗死患者出现发热后,不同OCSP分型脑梗死SIRS发生率与病死率有较强的一致性.     

全身炎症反应与肝肾综合征关系的研究

目的分析肝衰竭患者并发肝肾综合征(HRS)与全身炎症反应(SIRS)的关系。方法在137例肝衰竭患者中,合并HRS68例,单纯肝衰竭69例。收集两组患者Child-Pugh分级、终末期肝病模型(MELD)和SIRS评分。结果 HRS患者SIRS评分为0.70±0.86分,高于对照组0.36±0.54分(P<0.05),白细胞计数为8.96±4.45×109/L,显著高于对照组(5.79±2.40×109/L,P<0.05);HRS患者总胆红素和凝血酶原时间分别为404.5μmol/L和21.7±8.8s,高于对照组(259.0μmol/L和17.6±9.6s,P<0.05),而钠和氯分别为132.6±6.0mmol/L和92.2±9.1mmol/L,显著低于对照组(137.2±3.8mmol/L和99.5±9.3mmol/L,P<0.05)。结论 SIRS与肝衰竭患者并发HRS关系密切。     

全身炎症反应综合征防治研究进展

全身炎症反应综合征(SIRS)由各种严重损害因素引起,典型病理生理学特征为:广泛的炎细胞激活,多种细胞因子、炎性介质的失控性释放,血管内皮损伤与微循环障碍,全身持续高代谢状态,能量代谢障碍;进一步发展为多器官功能障碍综合征(MODS)。从发病机制着手,探索有效的临床治疗新对策,将     

急性脑出血后全身炎症反应综合征临床研究

目的了解急性脑出血后全身炎症反应综合征(SIRS)的发生率及其发生可能有关的因素,探讨SIRS在判断急性脑出血的病情和预后方面的临床价值.方法回顾性分析163例急性脑出血病人的临床资料,且以目前外科、危重病领域公认的SIRS、多器官功能障碍综合征(MODS)的诊断标准为依据,了解急性脑出血后SIRS和MODS的发生情况及相关问题.结果急性脑出血后SIRS的发生率为52%;出血量≤30 mL、出血破入脑室、随机血糖≥11.1 mmol/L的病人,SIRS的发生率分别较出血量＜30 mL、出血未破入脑室、随机血糖＜11.1 mmol/L的病人显著增高.脑出血后发生SIRS的病人,其MODS发生率、病死率均明显高于未发生SIRS的病人.结论急性脑出血后SIRS的发生率高,SIRS的发生提示病情危重,预后较差.     

血管瘤冷冻后全身炎症反应综合征2例报告

例 1,男 ,8个月。因嗜睡半天于 2 0 0 3年 3月 2 0日入院。患儿入院前 1天在外院行血管瘤冷冻术。查体 :T36 .5℃ ,P180次 /min,R6 0次 / min,体重 10 kg,嗜睡状 ,于背部见 6 cm× 8cm冷冻后创面 ,并渗出 ;咽峡无充血、颈软 ,双肺呼吸音粗 ,心音亢进 ,肝脾不大 ;四肢末稍循环好 ,肌张力正常 ,生理反射存在。外周血 WBC9× 10 9/ L、Hb113g/ L、RBC4 .4 5× 10 1 2 / L、PL T2 0 5×10 9/ L。血糖 5 .8mmol/ L。大便、尿、肝、肾功能、心肌酶、电解质均正常 ,颅脑 CT无异常 ,诊断为全身炎症反应综合征 ,予以吸氧、补液、抗炎治疗 4天…     

丙种球蛋白治疗小儿全身炎症反应综合征临床效果评价

目的探讨丙种球蛋白治疗小儿全身炎症反应综合征（SIRS）的临床效果。方法选择94例SIRS患儿,随机分为观察组和对照组,对照组采用常规方法治疗,观察组在常规治疗基础上加用丙种球蛋白,比较两组的疗效和不良反应。结果观察组显效30例,有效11例,无效6例;对照组显效19例,有效9例,无效19例,两组疗效比较差异有统计学意义（Uc=-2.789,P〈0.05）。观察组不良反应发生率为21.3%（10/47）,对照组不良反应发生率为17.0%,两组比较差异无统计学意义（χ2=0.28,P〉0.05）。结论丙种球蛋白治疗小儿全身炎症反应综合征疗效显著,值得在临床推广应用。     

Circulating levels of granulocyte macrophage colony-stimulating factor in patients with the systemic inflammatory response syndrome

OBJECTIVES: Granulocyte-macrophage colony stimulating factor (GM-CSF) is a key regulator cytokine that modulates the proliferation and maturation of polymorphonuclear and mononuclear progenitors. This study was designed to investigate and clarify the role of GM-CSF in 52 critically ill patients with systemic inflammatory response syndrome (SIRS). METHODS: Serum levels of GM-CSF were detected by an immunoenzyme assay. RESULTS: Our results clearly show that the serum concentrations of GM-CSF were significantly elevated in patients with infectious and noninfectious SIRS (33.2+/-45.7pg/ml, controls: 17.2+/-9.8pg/ml; p=0.0303). In addition, GM-CSF levels significantly decreased in patients with SIRS, particularly in patients with infectious SIRS, 5 and 7 days later. There was a clear tendency toward higher levels of GM-CSF in patients with poor, as compared with those having a good outcome of the disease. CONCLUSION: These results show that GM-CSF may play an important role in patients with infectious and noninfectious SIRS, and that GM-CSF levels progressively and significantly decrease in patients with infectious SIRS.     

急性缺血性脑卒中患者血小板活化水平与全身炎症反应综合征的相关性

目的 动态观察缺血性脑卒中患者外周血血小板活化水平,分析血小板活化与伴发全身炎症反应综合征(SIRS)的关系. 方法 动态监测缺血性脑卒中患者外周血血小板平均内含物浓度(MPC)和白细胞计数及发病早期血浆纤维蛋白原(FIB)和血小板聚集率等指标,比较SIRS组与无SIRS组患者的各项参数,对发病早期MPC水平与SIRS评分以及当日白细胞计数、FIB和血小板聚集率等进行相关性分析. 结果 MPC水平在发病第1天略有下降,从第2天至病程第45天一直保持较低水平,均值在229～242 g/L之间波动.SIRS组与无SIRS组比较发病早期FIB差异无统计学意义(t=1.835,P=0.07),其余各指标差异有统计学意义(均为P＜0.01).发病前3 d MPC水平与SIRS评分呈显著负相关(相关系数分别为-0.392、-0.376、-0.341,t值分别为3.484、3.405、3.125,均为P＜0.01),而与当日白细胞计数、FIB及血小板聚集率无相关性(P＞0.05). 结论 缺血性脑卒中患者整个病程期间血小板一直保持较活化的状态,伴发SIRS的患者发病早期血小板活化水平、白细胞计数和血小板聚集率均高于未伴发SIRS的患者.早期的血小板活化水平提示SIRS的严重程度,血小板活化可能是SIRS的独立危险因素.     

心脏手术患者体外膜肺氧合撤机后系统性炎症反应状况分析

目的:本研究旨在探讨体外膜肺氧合(ECMO)撤机后发生的系统性炎症反应(SIRS)和感染的发生率,影响因素及临床结局,以及是否有方法可以将SIRS从感染当中区分出来。方法:应用回顾性研究来分析ECMO撤机后的SIRS反应。SIRS的诊断标准为以下3条中包含两条及两条以上:发热、白细胞计数改变,血管活性药物用量加大。患者被分为两组:感染组Group I(n=14)和真炎性反应组Group TS(n=27)。分析撤机后感染率,真炎性反应率,院内生存率,ECMO前、中、后与感染相关的危险因素。结果:在83例成功ECMO脱机的患者中, 42例(50.6%)患者未见明显炎症反应(Group NO SIRS),41例(49.4%)患者发现存在撤机后炎症反应(Group SIRS)。在危险因素类似的情况下,其院内生存率分别是:NO SIRS(92.9%),Group TS(81.5%),Group I(42.9%)。结论:ECMO撤机后近50%患者发生炎症反应,其中约1/3患者被证实存在感染。感染患者的白细胞峰值以及体温峰值明显更高,尤其是白细胞高于30×10^9/L水平的患者。感染患者的生存率很低仅42.9%,不足非感染患者的50%。     

全身炎症反应中脂蛋白与细胞因子关系及其对预后影响

目的 研究全身炎症反应综合征(SIRS)患者血清脂蛋白水平与细胞因子水平的相关性及在预后中的预测价值。方法 检测SIRS患者血清脂蛋白与细胞因子TNFα、IL-6水平进行相关性分析，并分析脂蛋白水平与预后的相关性。结果 SIRS患者血清HDL、LDL与TNFα水平均呈显著性负相关，而CH和TG与TNFα的相关性无显著意义；血清HDL、LDL、CH和TG与IL-6水平均呈一定程度的负相关，但无显著意义；血清HDL、LDL与SIRS的预后有显著相关。结论 SIRS患者血清脂蛋白与细胞因子水平呈一定程度负相关，血清脂蛋白水平可能对SIRS的预后有一定的预测作用。     

Fever and systemic inflammatory response syndrome after retrograde intrarenal surgery: Risk factors and predictive model

This paper investigates the characteristics of patients who underwent retrograde intrarenal surgery (RIRS) to determine the predictive factors for post-operative fever and systemic inflammatory response syndrome (SIRS) and to construct a predictive nomogram to help with risk-stratification. A retrospective study of 337 patients who underwent RIRS was performed. Fever and SIRS were defined according to a previous consensus. Multivariate logistic regression coefficients were used to generate nomograms. Post-operative fever was found in 59 patients (17.5%), and SIRS was found in 22 patients (6.5%). Septic shock developed in 2 patients (0.6%). Three patients (0.9%) suffered from obstructive hydronephrosis. By multivariate analysis, concomitant diabetes mellitus (p = 0.015), high pre-operative C-reactive protein (CRP) (p = 0.015), long surgical times (p = 0.007), high stone burden (p = 0.004) and positive stone culture (p = 0.003) were independent risk factors for fever. Only high pre-operative CRP (p = 0.001), long surgical times (p = 0.001) and high stone burden (p = 0.001) were found to significantly affect the occurrence of SIRS. Predictive nomograms were built for fever and SIRS and the c-statistics for the two predictive models were 0.766 and 0.887, respectively. All patients recovered well after proper treatment, which included antipyretics, antibiotics, and inotropic support and nephrostomy when needed. In conclusion, high stone burden, long surgical time, positive stone culture, high pre-operative CRP and the presence of diabetes mellitus was could increase the risk of fever or SIRS after RIRS for kidney stone. The constructed nomograms could help clinicians in evaluating the risk for post-operative infectious complications.     

Excess visceral fat accumulation is a risk factor for postoperative systemic inflammatory response syndrome in patients with esophageal cancer

Background  Although visceral fat accumulation influences various body systems, its significance as a preoperative risk factor is unknown. This study analyzed the relationship between visceral fat accumulation and postoperative morbidity. Methods  The study group consisted of 64 male patients with body mass index (BMI) of 18.5 or more who underwent esophagectomy for esophageal cancer. Clinicopathological, surgical, and postoperative data were collected from medical records. Visceral fat area (VFA) was calculated at the navel level of preoperative CT scan by FatScan ver. 3.0. Results  Based on visceral fat area, patients were divided into high-VFA group (VFA ≥ 100 cm², n = 30) and low-VFA group (VFA < 100 cm², n = 34). Postoperative maximal CRP level was higher in the high-VFA group (23.4 ± 5.7 mg/dl) than the low-VFA group (18.5 ± 7.1 mg/dl, P = 0.004). The duration of systemic inflammatory response syndrome (SIRS) was significantly longer in high-VFA group (3.1 ± 3.4 days) than low-VFA group (1.7 ± 1.9 days, P = 0.048). There were no significant differences in postoperative complications. Differences in CRP and SIRS duration were not evident when the population was divided according to BMI. Visceral fat area (P = 0.001), blood loss (P = 0.029), and field of lymphadenectomy (P = 0.005) correlated with longer duration of SIRS postoperatively (>3 days). Multivariate analysis identified visceral fat area as the only significant determinant of longer duration of SIRS (P = 0.034; HR, 0.984). Conclusions  Patients with visceral fat area of more than 100 cm² are at high risk for prolonged postoperative SIRS.