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目的 提高对危重病患者发生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 2 89例SIRS患者的临床资料 ,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 ;MODS则符合各器官功能标准 ,而且在机体遭受打击 2 4小时后序贯出现两个或两个以上器官功能不全。结果 符合SIRS的危重病患者 2 89例 ,其中符合 2项标准者 75例 (2 5 9% ) ,3项者 10 4例 (36 0 % ) ,4项者 110例 (38 1% )。SIRS发展为MODS者2 0 3例 (70 2 % ) ,其中SIRS 2项者 5 4例 (2 6 6 % ) ,3项者 78例 (38 4% ) ,4项者 71例 (35 0 % )。死亡 15 0例 (73 9% ) ,其中SIRS2项者 38例 (2 5 3% ) ,3项者 5 9例 (39 3% ) ,4项者 5 3例 (35 3% ) ;二脏衰死亡 2 6例 (42 6 % ) ,三脏衰死亡 5 0例 (74 6 % ) ,四脏衰死亡 41例 (95 3% ) ,≥五脏衰死亡 33例 (10 0 0 % )。结论 SIRS可由细菌感染或非感染性疾病引起 ,且均能导致MODS ,阻断前炎症细胞因子和肿瘤坏死因子 -a的效应 ,对SIRS的发生有预防价值 ,可望降低MODS的发生。
Objective To improve the understanding of SIRS and MODS in critically ill patients. Methods Clinical data of 2 89 SIRS patients were analyzed. The patients were at least eligible for 2 SIRS criteria including fever, hypothermia, tachycardia, shortness of breath, or abnormal white blood cell count. MODS met the functional criteria of each organ and suffered severe attacks on the body 2 Two or more consecutive organ dysfunction occurred 4 hours later. Results A total of 2 89 critically ill patients were eligible for SIRS. Among them, 75 (25.9%) were eligible for 2 criteria, 104 were 3 (36 0%), and 110 (38 1%) were 4. SIRS developed 203 patients (70.2%) with MODS, including 54 cases (26.6%) of SIRS 2 cases, 78 cases (38.4%) of 3 cases and 71 cases (35% ). There were 15 0 (73 9%) deaths, of which 38 (23.3%) were SIRS2, 39 (39.3%) were 3 and 39 (53.3%) were 4 deaths There were 26 deaths (42.6%), 50 deaths (74.6%) in three dirty organs, 41 (95.3%) deaths in four internal organs, and 33 (100%) deaths in five internal organs. Conclusions SIRS can be caused by bacterial or non-infectious diseases and all can cause the effects of MODS, proinflammatory cytokines and tumor necrosis factor-a. It is of value in the prevention of SIRS and is expected to reduce the incidence of MODS.