儿科加强医疗病房全身炎症反应综合征和多器官功能不全综合征的临床分析

目的应用新概念———全身炎症反应综合征（ＳＩＲＳ）和多器官功能不全综合征（ＭＯＤＳ）认识多器官功能衰竭（ＭＯＦ）。方法回顾性总结分析１９９５年１月～１９９７年１２月我院儿科加强监护病房收治的危重患儿，根据Ｈａｙｄｅｎ修订的ＳＩＲＳ诊断标准和全国小儿急诊学组拟定的ＭＯＦ诊断标准进行临床分析。结果全组３０４例患儿，符合ＳＩＲＳ标准２５２例，占８２．９％．原发病有感染性疾病和非感染性疾病。在ＳＩＲＳ和ＭＯＤＳ病程发展过程中部分患儿出现一过性肝、肾、胃肠道和脑等器官功能受损的表现，最终进展为ＭＯＤＳ共６５例，占２５．８％。ＭＯＤＳ的病死率为４３．１％（２８／６５）。发生ＭＯＤＳ的高危因素为入院危重评分＜７５分，明显高代谢反应和合并Ｃ反应蛋白，而与年龄无明显关系。结论ＳＩＲＳ和ＭＯＤＳ是小儿加强医疗病房中常见病症，病死率较高。ＳＩＲＳ和急诊学组制定的ＭＯＦ诊断标准简单实用，但应根据美国胸科协会和危重病医学会倡议将ＭＯＦ更名为ＭＯＤＳ。ＳＩＲＳ和ＭＯＤＳ进展至器官功能衰竭前存在器官功能受损的表现，应予高度重视并早期干预。

Clinical analysis of systemic inflammatory response syndrome and multiple organ dysfunction syndrome in PICU

Objective To recognize multiple organ failure (MOF) with new concept of systemic inflammatory response syndrome and multiple organ dysfunction syndrome (SIRS/MODS).Methods According to the criteria of SIRS by Hayden and MOF by Chinese Pediatric Emergency Association, 304 cases in PICU were studied from Jan, 1995 to Dec, 1997.Results Two hundred and fifty two cases (82.9%) were diagnosed as SIRS. The underlying diseases were infectious or noninfectious diseases. During the course of SIRS, some patients had organs impairment and 25.8%(65/252) of SIRS patients developed MODS. The mortality rate of MODS was 43.1%. The risk factors of MODS included the score, proposed by a critical scoring system proposed by Chinese Pediatric Emergency Association, below 75, obvious hypermetabolic reaction and CPR.The development of MODS was not related to the age of cases.Conclusion SIRS/MODS is common in PICU and its mortality is high. The diagnostic criteria of SIRS and MOF are simple and practical. But the authors recommend the term of MOF should be changed to MODS. Organs impairment often exists before MODS develops and thus early intervention should be taken in such cases.