Systemic inflammatory response

Introduction Peripheral inflammatory response syndrome (SIRS): is a self-sustaining self-sustaining and self-destructive systemic inflammatory response caused by an uninfected or non-infectious cause of the body. It is a clinical process in which the body undergoes excessive stress response during repair and survival. When the body is attacked by exogenous damage or toxic substances, it can promote the initial inflammatory reaction, and at the same time, the endogenous immune inflammatory factors produced by the body form a "waterfall effect." Critically ill patients are most likely to trigger SIRS due to reduced compensatory anti-inflammatory response and metabolic dysfunction. Severe cases can lead to multiple organ dysfunction syndrome (MODS).

Cause

When the body is severely hit, there are symptoms and signs such as fever, leukocytosis, heart rate and rapid breathing. The clinical diagnosis is sepsis or sepsis. Since the 1980s, due to advances in clinical diagnostic techniques, it has been found that a common characteristic change in these patients is an increase in inflammatory mediators in plasma, which is not a necessary condition. Based on the above reasons, the concept of systemic inflammatory response syndrome (SIRS) was proposed at the joint meeting of the American College of Chest Physicians and the Emergency Medicine Association (ACCP/SCCM) in Chicago in 1991. In the second year at Critical Care Published on Med. The concept has been widely concerned and generally recognized, which has also promoted the development of the discipline. With the expansion of people's understanding of inflammation, the understanding of some diseases has undergone fundamental changes in recent years. It is recognized that multiple organ dysfunction of traumatic shock, rejection of skin transplantation, ischemia-reperfusion injury after myocardial infarction, etc. The basic pathology is inflammation.

Systemic inflamatory response syndrome (SIRS) is a new concept based on the understanding of the mechanism of multiple organ dysfunction syndrome (MODS). When the body is severely hit, it immediately generates complex defense confrontation, causing the stress response of the immune system, including the massive release of a variety of inflammatory mediators. This defensive response involving multiple systems of the body is called SIRS. It is an uncontrolled systemic inflammatory response. There are many types of hitting factors in the body, which can be summarized as infectious and non-infectious. The SIRS caused by infectious factors can be called sepsis.

Non-infectious factors such as trauma, surgery, ischemia, asphyxia, etc., although the clinical manifestations are similar to sepsis, but should not be called sepsis, but called SIRS. The meaning of SIRS is broader and more meaningful than sepsis. Regardless of the factors, once the SIRS occurs, its clinical characteristics resemble systemic infections, which are secondary to high metabolic performance after severe injury, and eventually develop into MODS, which is the leading cause of death. SIRS is the early manifestation of MODS and runs through the whole process of MODS, which is the essence of MODS.

Sepsis: The SIRS caused by an infection is called Sepsis. This infection is clinically confirmed to be a confirmed infection, but blood culture is not necessarily positive. Negative blood cultures are caused by non-bacterial infections, bacterial toxins or decomposition products that enter the blood circulation and bacteria that do not enter.

According to the degree of organ dysfunction, lactic acidosis, oliguria, hypoperfusion or hypotension, changes in consciousness, or persistent hypotension after infusion, sepsis can be further divided into severe sepsis (Severe sepsis), Sepsis with hypotension and septic shock.

Mechanisms of SIRS: infection, inflammation, tissue hypoxia-ischemia, reperfusion injury, and necrotic tissue stimulation are predisposing factors for SIRS. SIRS is currently considered to be the uncontrolled response of the body to various stimuli. The interaction and influence of many of these media systems and their by-products is very important.

This is a chain reaction that can continue even if the primary factor is eliminated or attenuated.

For example, in the case of severe infection, bacterial toxins activate inflammatory cells such as phagocytic cells, releasing a large amount of inflammatory mediators and cytotoxins, such as tumor necrosis factor, interleukin-1 and other activated granulocytes to damage endothelial cells, platelet adhesion, and further release of oxygen free radicals. The cascade-like chain reaction formed by lipid metabolites causes tissue cell damage. With the continuous development and deterioration of SIRS, it finally develops into MODS.

an examination

Related inspection

White blood cell count (WBC) blood routine serum interleukin-6 immunoturbidimetric technique serum amyloid A

Diagnosis can be made by having more than two of the following clinical manifestations:

(1) body temperature > 38 degrees or <36 degrees;

(2) Heart rate > 90 beats / min;

(3) Respiratory frequency > 20 beats / min or hyperventilation, PaCO 2 <32mmHg;

(4) WBC>12×109 or <4×109 or myelocytes>10%.

Differential diagnosis

Differential diagnosis of inflammatory response around the body:

1. Inflammatory cell infiltration: Inflammatory cell infiltration refers to the accumulation of a certain amount of inflammatory cells (such as neutrophils, acidic granulocytes, etc.) in the interstitial tissue, which is generally a manifestation of inflammatory response.

2, vascular allergic inflammation: vascular allergic inflammation is one of the common vascular inflammation, histopathological examination showed cellulosic necrosis of the blood vessel wall, a large number of neutrophil infiltration around the blood vessels.

3, mosquito bites inflammation: mosquito bites inflammation: mainly caused by mosquitoes, black mites (see Taiwan, Fujian, Guangdong, Guangxi, Hainan), white mites, fleas, bed bugs and other arthropod bites cause inflammatory skin diseases. These insects contain a variety of antigenic components in the saliva, which can cause toxic reactions and allergic reactions in the skin, resulting in dermatitis. This kind of dermatitis is good in summer and autumn. The rash often occurs in the exposed parts of the body. The skin is characterized by local redness, edema, pimple, bleeding, and sometimes blisters or bullae. In the center of the rash, there are often traces of bites. Conscious pruritus or itching, sometimes due to secondary infection, red line on the skin, indicating lymphatic inflammation, and sometimes local lymph nodes.

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