多发伤并发全身炎症反应综合征临床危险因素分析

摘要

Objective To study the clinical risk factors of multiple trauma complicated with systemic inflammatory response syndrome(SIRS) and provide the evidence for the early prevention and treatment. Methods The 289 patients with multiple trauma from the department of emergency medical of the people's hospital of Shaanxi province from February 2009 to February 2013 were enrolled. The study group were combined with SIRS and the control group were not. The cases were evaluated with acute physiology and chronic health Ⅱ(APACHE Ⅱ)score and injury severity score(ISS).The levels of CD4+ and CD8+ were measured by flow cytometry. The level of insulin was measured by chemiluminescence method.The level of C-reactive protein was measured by immune turbidimetry. Tumor necrosis factor alpha and interleukin 10,interleukin-6 were measured by double antibody enzyme linked immunosorbent clip art. Results The differences was statistically significant between the two groups in DIC,ISS,APACHE Ⅱ score(χ2=5.67,t=2.63,2.51,P<0.05);The differences were statistically significant between the two groups in IL-6,IL-10,INS(t=2.34,2.18,2.08,P<0.05);The ISS,APACHEⅡ,DIC,IL-6,IL-10,INS was risk factor for multiple trauma complicated with systemic inflammatory response syndrome. Conclusion The ISS,APACHE Ⅱ,DIC,IL-6,IL-10,INS are risk factors for multi ple trauma complicated SIRS and the change of the six influence factors should be paid attention to during multiple trauma.%目的：探讨多发伤并发全身炎症反应综合征（SIRS）临床危险因素，为早期预防治疗全身炎症反应综合征提供依据。方法2009年2月至2013年2月急诊就诊多发伤患者289例，合并全身炎症反应综合征为观察组，未合并炎性反应综合征为对照组。病例的评估采用急性生理学和慢性健康状况Ⅱ（APACHEⅡ）评分和损伤严重度评分（ISS）。CD4+，CD8+水平测量采用流式细胞仪。胰岛素（Insulin，INS）水平测量采用化学发光法。C-反应蛋白（C reactive protein，CRP）测量采用免疫比浊法。肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）、白细胞介素10（interleukin-10，IL-10）、白细胞介素-6（interleukin-6，IL-6）的测定采用酶联免疫吸附双抗体夹心法。结果 DIC、ISS、APACHEⅡ评分两组间差异有统计学意义（χ2=5.67，t=2.63、2.51， P<0.05）；IL-6、IL-10、INS两组间差异有统计学意义（t=2.34、2.18、2.08，P<0.05）；ISS、APACHEⅡ、DIC、IL-6、IL-10、INS是多发伤并发全身炎症反应综合征的危险因素，其中IL-10的OR值最大，其次为DIC。结论 ISS、APACHEⅡ、DIC、IL-6、IL-10、INS是多发伤并发全身炎症反应综合征的危险因素，治疗多发伤时应注意这6种影响因素的变化。