Ertel W, Keel M, Marty D, Hoop R, Safret A, Stocker R, Trentz O
Klinik für Unfallchirurgie, Universitätsspital Zürich.
Unfallchirurg. 1998 Jul;101(7):520-6. doi: 10.1007/s001130050304.
The association between the increasing severity of systemic inflammatory response syndrome (SIRS) and the incidence of post-traumatic 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 > or = 9 < or = 16 points (n = 626); group B: ISS > 16 < 40 points (n = 589); group C: ISS > or = 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.
对1278例受伤患者进行回顾性研究，以探讨全身炎症反应综合征（SIRS）严重程度增加与创伤后并发症发生率及死亡率之间的关联。根据损伤严重程度评分（ISS）将患者分为三组（A组：ISS≥9且≤16分（n = 626）；B组：ISS＞16且＜40分（n = 589）；C组：ISS≥40分（n = 63））。SIRS根据美国共识会议的标准定义。符合标准的数量决定其严重程度：中度SIRS：符合2条标准；中度SIRS：符合3条标准；重度SIRS：符合4条标准。此外，急性呼吸窘迫综合征（ARDS）根据Murray评分定义，多器官功能障碍综合征（MODS）根据Goris评分定义。A组SIRS发生率为42%，B组为70%，C组为100%（p＜0.05）。SIRS的严重程度随创伤严重程度增加而升高。此外，所有受伤患者中有178例（14%）发生了感染性并发症。与SIRS并行，这些感染性并发症的发生率与创伤严重程度相关。ARDS和MODS的发生及严重程度与SIRS和感染性并发症严重程度增加相关。在无SIRS的患者中，15%发生了ARDS，21%发生了MODS。相比之下，重度SIRS和感染性并发症患者中，99%发生了ARDS，97%发生了MODS。在这些患者中，未发现ISS与ARDS或MODS发生率之间存在相关性。从SIRS到感染性休克，死亡率也呈逐步上升趋势。轻度SIRS患者中有13例（5%）死亡，中度SIRS患者中有32例（13%）死亡，重度SIRS患者的死亡率为19%（P＜0.05）。此外，发现感染性并发症发生率与死亡率之间存在显著相关性。发生败血症的受伤患者死亡率为13%，严重败血症患者为23%，感染性休克患者为33%（p＜0.05）。因此，SIRS严重程度增加与创伤后ARDS、MODS的发生及死亡率相关。使用符合SIRS标准的数量对全身炎症进行分类，其严重程度可能对受伤患者的创伤后并发症及预后具有预测作用。
