急性脑出血并发全身炎症反应综合征致多器官功能障碍综合征患者血清一氧化氮、一氧化氮合酶的变化

目的　探讨急性脑出血并发全身炎症反应综合征(SIRS)致多器官功能障碍综合征(MODS)的可能机制及一氧化氮(NO)、一氧化氮合酶(NOS)在急性脑出血致MODS发生发展中的作用。方法　观察急性脑出血并发SIRS及导致MODS的发生率。应用硝酸还原酶法及比色法动态监测73例急性脑出血患者血清NO及NOS的水平,并以20名健康人为对照。结果　脑出血并发SIRS的发生率为47. 95% (35 /73),其中74. 29% (26 /35)导致MODS。73例患者血清NO及NOS水平均明显高于正常对照组,且随病情的加重呈上升的趋势(均P<0. 01);重型MODS组较轻型组、死亡MODS组较存活组差异有极显著性(均P<0 01)。结论脑出血并发SIRS是导致MODS的主要机制,NO、NOS参与了脑出血并发SIRS及导致MODS的病理生理过程,并可作为一客观指标判断脑出血的病情及预后。

Changes of serum nitric oxide and nitric oxide synthase in acute cerebral hemorrhage with multiple organ dysfunction syndrome caused by systemic inflammatory response syndrome

Objective To explore the possible mechanism of acute cerebral hemorrhage with systemic inflammatory response syndrome (SIRS) which caused multiple organ dysfunction syndrome (MODS), and to investigate the significance of serum nitric oxide (NO) and nitric oxide synthase (NOS) in the development of acute cerebral hemorrhage from SIRS to MODS.Methods The incidence rate of acute cerebral hemorrhage leading to SIRS and MODS was investigated. Serum NO and NOS levels in 73 patients with acute cerebral hemorrhage were detected dynamically by nitratase and chromometry methods. 20 normal healthy people were adopted as control group.Results The incidence rate of cerebral hemorrhage accompanied with SIRS was 47.95%(35/73),74.29%(26/35) of which leaded to MODS. 73 patients serum NO and NOS levels were elevated obviously, and the differences were significant compared with control group (all P<0.01). Furthermore, NO and NOS levels in severe patients with MODS group were markedly higher than those in mild patients, and they were also higher in patients with MODS who died within 3 days than in patients who were survival (all P<0.01).Conclusions Cerebral hemorrhage complicated with SIRS is the main mechanism of MODS. High levels of No and NOS may be involved in the development of MODS following acute cerebral hemorrhage. They can be regarded as laboratory index for judging the condition and prognosis in patients with cerebral hemorrhage.