炎症综合征的临床治疗策略.pptVIP

内容提要 对SIRS的认识 控制炎症反应措施 1、对SIRS的认识 Endotoxin Release Upon Cell Lysis Richard Pfeiffer 1892 LPS信号传递 细胞因子的过度释放 Cell Injury 细胞免疫功能变化 炎症因子的释放不仅仅来源于病源微生物加强医疗措施同样能引起炎症过程 机械通气 Shear Stress induced lung injury 环丙沙星VS 头孢他啶诱导细胞因子释放 环丙沙星VS 头孢他啶诱导细胞因子释放 IL-10/ TNFαRatio in High Baseline Patients 即使“喝凉水”都会伤肺！ SIRS的发生与失衡 感染、创伤、休克等是始动因素 宿主的反应性与调节能力是决定因素 医生的救命的手也在推波逐澜 2、控制炎症反应措施 28-Day All-Cause Mortality 皮质激素应用 激素替代治疗 50mg Q6h iv 能有效提高休克的逆转率 不改变28天病死率 2007欧洲ESICM 年会报告 CRRT与SIRS CRRT vs IHD for renal recovery CRRT improve survival of burned Casualties with AKI Reduced the use of vasopressors Decreased mortality Dose of CRRTRonco et al., Lancet 2000 Influence of UR on Mortality 细胞因子清除原理 Diffusive vs. convective therapy: Effects on mediators of inflammation in patients with severe systemic inflammatory response syndrome Confirmed Advances Maintain electrolyte balance Ensure advanced life support It has not been identified to be related with cytokines clearance 乌司他丁 Effect of UTI on TNFα Effect of UTI on MPO in Lung tissue Protective effect of UTI on LPS induced lung injury Protective effect of UTI on LPS induced lung injury LPS Induced Hepatic Cell injury in UTI Knock-out Mice Clinical Data 尽管在急性重症胰腺炎以及急性肺治疗中得到广泛应用 No any solid data available to support the beneficial effect of UTI on SIRS or cell injury yet. RCT is urgently needed 免疫状态干预 治疗组与对照组的比较 免疫调理治疗任重道远 当前的认识 0 20 40 80 60 2 3 1 0 4 0 500 1000 1500 IL-6 TNF IL-1 IL-8 TNF (U/ml) IL-1 (pg/ml) IL-6 (U/ml) IL-8 (pg/ml) t/h (Hoffmann, 1997) Plasma concentrations in sepsis patients durin high-volume CRRT The mediator delivery hypothesis PRISM 2: Pediatric Risk of Motarlity Onei H, Eur J Clin Invest 2001 Onei H, Eur J Clin Invest 2001 Dose response of UTI on TF in LPS stimulated monocytes Perenlei ME, Thromb Haemost, 2005 UTI (-/-) LPS UTI (WT) LPS UTI (-/-) Vehicle UTI (WT) Vehicle Inoue, Mol Pharmacol 2004 Onei H, Eur J Clin Invest 2001 UTI (-/-) LPS UTI (WT) LPS UTI