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Application Value of the Concept of SIRS in Children with Pneumonia

Author: WangXiuYu
Tutor: HuangJingZuo
School: Tianjin Medical University
Course: Pediatrics
Keywords: systemic inflammatory response syndrome sepsis multiple organ dysfunction syndrome children pneumonia complication risk incidence
CLC: R725.6
Type: Master's thesis
Year: 2007
Downloads: 102
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Abstract

Background: In 1991, American College of chest physicians/Society forcritical Care Medicine introduced the concept of systemic inflammatoryresponse syndrome(SIRS) first. Clinically we found that trauma, empyrosis,infection, autoimmune disease and pancreatitis and so on could also resultin some homoplastic systematic reactions that include fever, the increaseof leucocyte, increased cardiac output, accelerated breathing and thedecrease of blood vessels’ force of resistance. These systematicreactions did not explain the characters and localizations of the primarydiseases. They only reflected the serious degrees of indiscriminateinternal environments resulted in by the primary diseases. If theycontinued to develop and runaway, they would result in shock, apoptosis,MODS and life-treatening condition. To aim directly at the phenomenon,the ACCP/SCCM introduced the concept of SIRS. SIRS was an inflammatoryreaction what organism produced when it was stimulated by seriousinfection, trauma, empyrosis, oxygen deficiency and the damage ofreperfusion. The concept of SIRS was introduced on the basis of thedeepened recognition to the inflammation. It had practical meaning todirect clinic. In fact, what SIRS described was that the organism produceda series of cascade reactions when it was wounded. The purpose ofestablishing the definition of SIRS was to provide uniform applicationfoundation for the diagnosis and treatment. In 2002, the firstinternational pediatric consensus conference about sepsis was held. Inthe during of the conference, the concept of SIRS was introduced andconsented. It was essential and feasible that the concept of sepsis was turned into "sepsis with SIRS". The contradiction between the serveinfectious diseases and the theories of infection appeared. On the basisof the background, the new concept of SIRS/sepsis was introduced. It hasbeen practiced over 10 years and accepted by the majority of the workerswho are engaged in clinical medicine, preclinical medicine andepidemiology. The concept of SIRS/sepsis is different from the orthodoxconcepts of the other diseases that are researched on the basis of organpathology. It accords with systemic theories of biomedicine. At present,MODS is thought to be the most important reason that results in death ofchild. The theory of SIRS is important one that results in MODS. MODSphase is the most serious phase during the development of SIRS. Becauseit is difficult to treat the disease of MODS, to think highly of thetreatment of SIRS is equal to discover and prevent beforehand MODS early.Children pneumonia is a common respiratory infectional disease whoseincidence is the first in children spectrum of disease in our country.We have enough reasons to think highly of them. At the same time, we shouldmonitor actively the patients who have more dangers in order that we caninstitute reasonable and effective treatments and precautionalstrategies that can improve prognosis.Objective: To explore the risk and value of the concept of SIRS amongthe patients with SIRS.Methods: We collect hospitalized 2824 patients whose first diagnosiswere children pneumonia in TianJin Children Hospital from September,2005 to December, 2006. According to the criteria of SIRS, All the patientswere divided into two groups. We observed the differences between themfrom their clinical characters and laboratory examinations which included bellows complication, secondary infection, respiratory failure,plate-reduction, hyponatremia, increase of CRP and the persistent daysof fever. According to the age, all the patients were divided into 3 groups(groupⅠincluded the patients whose ages ranged from 1 month to 1 year,groupⅡincluded the patients whose ages ranged from 1 year to 3 years,groupⅢincluded the patients whose ages ranged from 3 years to 14years)。We compared the incidences of children pneumonia with SIRS andthe risk factors among them. Blood routines were examed by blood cell countmachine, the quantities of blood natrium were measured by selectrodemethod, the quantities of CRP in blood were assayed by quantitative assay.Statistical analyses were performed with SPSS 12.0.Results:1. All the incidences of bellows complication, secondary infection,respiratory failure, plate-reduction, hyponatremia, increase of CRPamong the patients according with the criteria of SIRS were higher thanthose among the others. The persistent days of the fever were longer tooin the former. All the differences had statistical significant. Hospitaldays, pre-hospital course of diseases (days), sex and age among the twogroups have no significant differences.2. According to age, all the patients were divided into 3 groups. Theincidence of children pneumonia with SIRS in groupⅢwas the highestand the one in groupⅠwas the least. Among the patients with childrenpneumonia with SIRS, the incidences of bellows complication andrespiratory failure in groupⅠwere the highest, but the incidence ofincrease of CRP in groupⅠwas the least.Conclusions: 1. The patients with SIRS had severe states of an illness and high risksat bellows complication, secondary infection, respiratory failure,plate-reduction, hyponatremia, increase of CRP and the persistent daysof the fever.2. The incidence and the clinical character of children pneumonia withSIRS were related to the ages of the patients. The incidence of childrenpneumonia with SIRS in groupⅠwhose ages ranged from 1 month to 1 yearwas the least, but the risks of bellows complication and respiratoryfailure in groupⅠwere the highest.3. By making use of the diagnostic criteria of SIRS, we can evaluateeffectually the dangerous degrees of the pneumonia patients, which ismeaningful to guide the pediatric clinic. Clinicians must think highlyof the diagnose, treatment and prevent beforehand of SIRS.

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