高龄全身炎症反应综合征54例临床研究

Systemic inflammatory response syndrome: clinical study of 54 very old patients

摘要:

目的 探讨高龄全身炎症反应综合征（SIRS）的临床特征及治疗与预后的关系。方法 选择南京军区南京总医院2006年2月至2012年6月收治的高龄SIRS 54例患者的临床资料，随机分为治疗组和对照组，对照组28例，治疗组26例。两组患者同时进行原发病治疗、充分的抗感染、基础的呼吸支持。治疗组同时采取了呼吸支持的阶梯化管理并联合规范化营养支持及免疫调节。对比分析两组发生多器官功能障碍综合征（MODS）的情况以及病死率。结果 治疗组SIRS致MODS的发生率为38.5%（10/26），病死率7.7%（2/26），显著低于对照组的57.1%（16/28）和28.6%（8/28），且差异有统计学意义（P＜0.05）。结论 高龄SIRS持续进展将导致MODS的发生。MODS是导致高龄重症感染患者死亡的主要原因。积极的规范化营养支持及免疫调理治疗可显著提高高龄SIRS患者的治愈率。 【关键词】老年人, 80以上; 全身炎症反应综合征; 多器官功能衰竭; 免疫调节剂

Abstract:

Objective To investigate the clinical characteristics of very old patients with systemic inflammatory response syndrome (SIRS) and the relationship between treatment options and prognosis. Methods Fifty-four very old patients with SIRS were randomly divided into two groups. The control group included 28 patients, receiving only a standard anti-infection treatment and traditional respiratory support, and the treatment group included 26 patients, receiving a stepwise respiratory, nutrition support and immunomodulator besides a standard anti-infection treatment. Their differences in morbidity and fatality rate of multiple organ dysfunctions syndrome （MODS） were compared and analyzed. Results The morbidity and fatality rate of MODS in the treatment group were 38.5% and 7.7% respectively, and were significantly lower than those in the control group (57.1% and 28.6% respectively, P＜0.05). Conclusion In the elderly, progressive SIRS will lead to the occurrence of MODS. MODS is a major cause of death in the elderly patients with severe infection. Stepwise respiratory plus nutrition support and immunomodulator can significantly improve the cure rate of SIRS.