WordNet

(physical chemistry) a sample of matter in which substances in different phases are in equilibrium; "in a static system oil cannot be replaced by water on a surface"; "a system generating hydrogen peroxide"
instrumentality that combines interrelated interacting artifacts designed to work as a coherent entity; "he bought a new stereo system"; "the system consists of a motor and a small computer"
a group of independent but interrelated elements comprising a unified whole; "a vast system of production and distribution and consumption keep the country going" (同)scheme
a complex of methods or rules governing behavior; "they have to operate under a system they oppose"; "that language has a complex system for indicating gender" (同)system of rules
a group of physiologically or anatomically related organs or parts; "the body has a system of organs for digestion"
a procedure or process for obtaining an objective; "they had to devise a system that did not depend on cooperation"
the living body considered as made up of interdependent components forming a unified whole; "exercise helped him get the alcohol out of his system"
a result; "this situation developed in response to events in Africa"
a phrase recited or sung by the congregation following a versicle by the priest or minister
the manner in which an electrical or mechanical device responds to an input signal or a range of input signals
a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
affecting an entire system; "a systemic poison"
characterized or caused by inflammation; "an inflammatory process"; "an inflammatory response"

PrepTutorEJDIC

〈C〉(関連した部分から成る)『体系』,系統,組織[網],装置 / 〈C〉(教育・政治などの)『制度』,機構;《the~》体制 / 〈C〉(思想・学問などの)『体系』,学説 / 〈C〉(…の)『方法』,方式,やり方《+of doing》 / 〈U〉正しい方針(筋道,順序) / 〈U〉《the~》(身体の)組織,系統 / 〈U〉《the~,one's~》身体,全身
〈C〉(…に対する)『返事』,『返答』《+『to』+『名』》 / 〈C〉〈U〉(…に対する)『反応』,『反響』《『to』+『名』》 / 〈C〉応答歌,応唱(牧師にならって合唱隊・会衆が短い祈り・歌を応答すること)
(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
(身体・言語のように)体系の,組織の / 全身の,全身的
炎症を起こす,炎症性の / 憤激させる,扇動的な

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/05/15 19:18:31」(JST)

wiki en

Systemic inflammatory response syndrome (SIRS) is an inflammatory state affecting the whole body, frequently a response of the immune system to infection, but not necessarily so. It is related to sepsis, a condition in which individuals both meet criteria for SIRS and have a known or highly suspected infection.

Classification

SIRS is a serious condition related to systemic inflammation, organ dysfunction, and organ failure. It is a subset of cytokine storm, in which there is abnormal regulation of various cytokines.^[1] SIRS is also closely related to sepsis, in which patients satisfy criteria for SIRS and have a suspected or proven infection.^[2]^[3]^[4]

Definition

**Systemic inflammatory response syndrome**^[2]
Finding	Value
Temperature	<36 °C (96.8 °F) or >38 °C (100.4 °F)
Heart rate	>90/min
Respiratory rate	>20/min or PaCO2<32 mmHg (4.3 kPa)
WBC	<4x10⁹/L (<4000/mm³), >12x10⁹/L (>12,000/mm³), or 10% bands

SIRS was first described by Dr. William R. Nelson, of the University of Toronto, in a presentation to the Nordic Micro Circulation meeting in Geilo, Norway in February 1983. There was intent to encourage a definition which dealt with the multiple (rather than a single) etiologies associated with organ dysfunction and failure following a hypotensive shock episode. The active pathways leading to such pathophysiology may include fibrin deposition, platelet aggregation, coagulopathies and leukocyte liposomal release. The implication of such a definition suggests that recognition of the activation of one such pathway is often indicative of that additional pathophysiologic processes are also active and that these pathways are synergistically destructive. The clinical condition may lead to renal failure, respiratory distress syndrome, central nervous system dysfunction and possible gastrointestinal bleeding.

Criteria for SIRS were established in 1992 as part of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference.^[2] The conference concluded that the manifestations of SIRS include, but are not limited to:

Body temperature less than 36°C or greater than 38°C
Heart rate greater than 90 beats per minute
Tachypnea (high respiratory rate), with greater than 20 breaths per minute; or, an arterial partial pressure of carbon dioxide less than 4.3 kPa (32 mmHg)
White blood cell count less than 4000 cells/mm³ (4 x 10⁹ cells/L) or greater than 12,000 cells/mm³ (12 x 10⁹ cells/L); or the presence of greater than 10% immature neutrophils (band forms)

SIRS can be diagnosed when two or more of these criteria are present.^[3]^[4]^[5]^[6]

The International Pediatric Sepsis Consensus has proposed some changes to adapt these criteria to the pediatric population.^[7]

Fever and leukocytosis are features of the acute-phase reaction, while tachycardia is often the initial sign of hemodynamic compromise. Tachypnea may be related to the increased metabolic stress due to infection and inflammation, but may also be an ominous sign of inadequate perfusion resulting in the onset of anaerobic cellular metabolism.

In children, the SIRS criteria are modified in the following fashion:^[8]

Heart rate is greater than 2 standard deviations above normal for age in the absence of stimuli such as pain and drug administration, or unexplained persistent elevation for greater than 30 minutes to 4 hours. In infants, also includes Heart rate less than 10th percentile for age in the absence of vagal stimuli, beta-blockers, or congenital heart disease or unexplained persistent depression for greater than 30 minutes.
Body temperature obtained orally, rectally, from Foley catheter probe, or from central venous catheter probe less than 36 °C or greater than 38.5 °C. Temperature must be abnormal to qualify as SIRS in pediatric patients.
Respiratory rate greater than 2 standard deviations above normal for age or the requirement for mechanical ventilation not related to neuromuscular disease or the administration of anesthesia.
White blood cell count elevated or depressed for age not related to chemotherapy, or greater than 10% bands plus other immature forms.

Note that SIRS criteria are very non-specific,^[9] and must be interpreted carefully within the clinical context. These criteria exist primarily for the purpose of more objectively classifying critically ill patients so that future clinical studies may be more rigorous and more easily reproducible.

As an alternative, when two or more of the systemic inflammatory response syndrome criteria are met without evidence of infection, patients may be diagnosed simply with "SIRS." Patients with SIRS and acute organ dysfunction may be termed "severe SIRS."

Causes

The causes of SIRS are broadly classified as infectious or noninfectious. As above, when SIRS is due to an infection, it is considered sepsis. Noninfectious causes of SIRS include trauma, burns, pancreatitis, ischemia, and hemorrhage.^[2]^[3]^[4]

Other causes include:^[2]^[3]^[4]

Complications of surgery
Adrenal insufficiency
Pulmonary embolism
Complicated aortic aneurysm
Cardiac tamponade
Anaphylaxis
Drug overdose

Treatment

Generally, the treatment for SIRS is directed towards the underlying problem or inciting cause (i.e. adequate fluid replacement for hypovolemia, IVF/NPO for pancreatitis, epinephrine/steroids/diphenhydramine for anaphylaxis).[1] Selenium, glutamine, and eicosapentaenoic acid have shown effectiveness in improving symptoms in clinical trials.^[10]^[11] Other antioxidants such as vitamin E may be helpful as well.^[12]

Complications

SIRS is frequently complicated by failure of one or more organs or organ systems.^[2]^[3]^[4] The complications of SIRS include:

Acute lung injury
Acute kidney injury
Shock
Multiple organ dysfunction syndrome

References

^ Parsons, Melissa, Cytokine Storm in the Pediatric Oncology Patient (section "Differential Diagnoses and Workup", Journal of Pediatric Oncology Nursing, 27(5) Aug/Sep 2010, 253–258.
^ ^a ^b ^c ^d ^e ^f "American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis". Crit. Care Med. 20 (6): 864–74. 1992. doi:10.1097/00003246-199206000-00025. PMID 1597042. http://www.chestjournal.org/content/101/6/1644.full.pdf.
^ ^a ^b ^c ^d ^e Rippe, James M.; Irwin, Richard S.; Cerra, Frank B (1999). Irwin and Rippe's intensive care medicine. Philadelphia: Lippincott-Raven. ISBN 0-7817-1425-7.
^ ^a ^b ^c ^d ^e Marino, Paul L. (1998). The ICU book. Baltimore: Williams & Wilkins. ISBN 0-683-05565-8.
^ Sharma S, Steven M. Septic Shock. eMedicine.com, URL: http://www.emedicine.com/MED/topic2101.htm Accessed on Nov 20, 2005.
^ Tsiotou AG, Sakorafas GH, Anagnostopoulos G, Bramis J (March 2005). "Septic shock; current pathogenetic concepts from a clinical perspective". Medical Science Monitor : International Medical Journal of Experimental and Clinical Research 11 (3): RA76–85. PMID 15735579. http://www.medscimonit.com/fulltxt.php?ICID=15400.
^ Brahm Goldstein et al., International pediatric sepsis consensus, Pediatr Crit Care Med 2005 Vol. 6, No. 1
^ Goldstein B, Giroir B, Randolph A (2005). "International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics". Pediatr Crit Care Med 6 (1): 2–8. doi:10.1097/01.PCC.0000149131.72248.E6. PMID 15636651. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1529-7535&volume=6&issue=1&spage=2.
^ Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (Apr 2003). "2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference". Crit Care Med 31 (4): 1250–1256. doi:10.1097/01.CCM.0000050454.01978.3B. PMID 12682500. http://www.ccmjournal.com/pt/re/ccm/abstract.00003246-200304000-00038.htm.
^ Berger MM, Chioléro RL (September 2007). "Antioxidant supplementation in sepsis and systemic inflammatory response syndrome". Critical Care Medicine 35 (9 Suppl): S584–90. doi:10.1097/01.CCM.0000279189.81529.C4. PMID 17713413.
^ Rinaldi, S; Landucci, F, De Gaudio, AR (2009 Sep). "Antioxidant therapy in critically septic patients.". Current drug targets 10 (9): 872–80. doi:10.2174/138945009789108774. PMID 19799541.
^ Bulger EM, Maier RV (February 2003). "An argument for Vitamin E supplementation in the management of systemic inflammatory response syndrome". Shock 19 (2): 99–103. doi:10.1097/00024382-200302000-00001. PMID 12578114.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 敗血症および全身性炎症反応症候群：定義、疫学、および予後 sepsis and the systemic inflammatory response syndrome definitions epidemiology and prognosis
2. 小児における全身性炎症反応症候群（SIRS）および敗血症：定義、疫学、臨床症状、および診断 systemic inflammatory response syndrome sirs and sepsis in children definitions epidemiology clinical manifestations and diagnosis
3. 合併症リスクの低い成人癌患者における発熱性好中球減少症候群の治療および予防 treatment and prevention of neutropenic fever syndromes in adult cancer patients at low risk for complications
4. 敗血症性ショック：小児における迅速な覚知および初期蘇生 septic shock rapid recognition and initial resuscitation in children
5. 早産児における細菌性敗血症の臨床的特徴および診断 clinical features and diagnosis of bacterial sepsis in the preterm infant

English Journal

Effects of sivelestat on bronchial inflammatory responses after esophagectomy.

Yamaguchi K, Sugasawa Y, Takeuchi K, Kugimiya T, Kumakura S, Iwanuma Y, Kajiyama Y, Tsurumaru M, Nagaoka I, Inada E.SourceDepartment of Anaesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
International journal of molecular medicine.Int J Mol Med.2011 Aug;28(2):187-92. doi: 10.3892/ijmm.2011.690. Epub 2011 May 6.
Post-operative pulmonary complications such as systemic inflammatory response syndrome (SIRS), acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are strongly associated with morbidity and mortality after esophagectomy. Post-operative administration of sivelestat sodium hydrate (
PMID 21567070

The systemic inflammatory response syndrome and sequential organ failure assessment scores are effective triage markers following paracetamol (acetaminophen) overdose.

Craig DG, Reid TW, Martin KG, Davidson JS, Hayes PC, Simpson KJ.SourceScottish Liver Transplantation Unit, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK. Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK.
Alimentary pharmacology & therapeutics.Aliment Pharmacol Ther.2011 Jul;34(2):219-28. doi: 10.1111/j.1365-2036.2011.04687.x. Epub 2011 May 10.
Aliment Pharmacol Ther 2011; 34: 219-228 SUMMARY: Background? The systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores are widely used as prognostic markers in critical care settings and could improve triage of high-risk paracetamol (acetaminophen) o
PMID 21554357

Japanese Journal

Imbalance between macrophage migration inhibitory factor and cortisol induces multiple organ dysfunction in patients with blunt trauma

Inflammation 34(3), 193-197, 2011-06
… Migration inhibitory factor (MIF) is associated with multiple organ dysfunction syndrome (MODS) in patients with systemic inflammatory response syndrome (SIRS). … The results show that MIF and TNF-α play an important role together in post-traumatic inflammatory response. …
NAID 120003025305

急性膵炎における全身性免疫応答の解析 (特集重症急性膵炎の病態解明と治療の新展開)

佐藤晃彦,廣田衛久,下瀬川徹
消化器内科 52(2), 219-224, 2011-02
NAID 40018768283

Related Pictures

★リンクテーブル★

リンク元	「敗血症」「全身性炎症反応症候群」「SIRS」「sepsis syndrome」
関連記事	「systemic」「inflammatory」「system」「response」「syndrome」

「敗血症」

Systemic inflammatory response syndrome
	Classification and external resources
ICD-9	995.90

　　[★]

英: sepsis, (昔の概念→)septicemia
関

定義

感染症による全身性炎症反応症候群(SIRS)をセプシス(sepsis, 広義の敗血症？)とする
感染症の病原体は、一般細菌(グラム陽性菌・陰性菌)、真菌、寄生虫、ウイルスなど
皮膚や粘膜の傷とか、種々の臓器にある感染巣から、細菌がリンパ流から血中に入り、全身に播種されて、新たに転移性の感染巣をつくり、重篤な全身症状を引き起こす。

全身性炎症反応症候群の診断基準

下記項目のうち2項目以上が当てはまる

1. 体温>38℃ or 体温<36℃
2. 心拍数>90bpm
3. 呼吸数>20回/min or PaCO2<32mmHg
4. (白血球数>12,000/ul or 白血球数<4,000/ul) or ( 幼若好中球>10% )　←　ここでいう幼若好中球とは桿状好中球のことである。

敗血症の周辺疾患概念

1. 全身性炎症反応症候群 systemic inflammatory response syndrome SIRS

発熱や白血球増加などの全身の炎症の徴候によって特徴づけられる病態(SIRSの診断基準に合致する病態)

2. 敗血症 sepsis

SIRSが感染の結果である場合

3. 重症敗血症 severe sepsis

主要臓器障害を伴う敗血症

4. 敗血症性ショック septic shock

輸液投与に不応性の低血圧を伴う重症敗血症

5. 多臓器機能障害症候群 multiorgan dysfunction syndrome MODS

2つ以上の主要臓器の機能異常

6. 多臓器不全 multiorgan failure MOF

2つ以上の主要臓器の不全状態

病態生理

LPS

LPSが血液凝固を促進→血小板、フィブリノゲン、凝固因子消費　→　血栓形成　→　プラスミノゲンを消費して血栓溶解 (FDP産生)　→

→出血傾向　→　皮下出血、歯肉出血、顕微鏡的血尿(出血性敗血症)

原因となる病原体

細菌：グラム陽性球菌(ブドウ球菌、レンサ球菌)、グラム陰性桿菌(大腸菌、緑膿菌、肺炎桿菌、プロテウス)
真菌：Candida albicans

症状

悪寒、戦慄を伴う発熱、頻脈、頻呼吸、全身倦怠感、呼吸困難、意識障害、ショック、乏尿
敗血症による多臓器不全で障害を受けやすい臓器：肺、腎臓、心血管系、中枢神経系

重症敗血症の40%に急性呼吸促迫症候群を合併

検査

血液検査

白血球：12,000/ul以上のことが多い(SIRSの定義)

左方移動、重症例では白血球減少

血小板数：血管内凝固に伴い低下
CRP：基準値以上
凝固系・線溶系：凝固能低下、線溶系亢進

培養

血液培養
カテーテルの先端(留置カテーテルがある場合)

治療 (ICU.644)

酸素投与

敗血症における組織の酸素化

敗血症では細胞の酸素摂取能が損なわれている　→　重症敗血症患者の組織酸素濃度がなぜ健常者よりも高くなる　(ICU.645)
重症敗血症や敗血症性ショックにおいては

敗血症における酸素摂取量(ICU.645)

敗血症における酸素摂取量(VO2)の増加は、好中球の活性化の過程(呼吸バースト)で酸素が消費された結果。

初期蘇生

重症敗血症や敗血症性ショックの患者に対する最初の6時間の管理目標

1.中心静脈庄8-12mmHg
2.平均動脈庄≧65mmHg
3.尿量≧0.5 mL/kg/h
4.SVO2≧70% or SCVO2≧70%

SVO2：混合静脈血酸素飽和度、肺動脈血酸素飽和度

SCVO2：中心静脈血酸素飽和度、上大静脈血酸素飽和度

輸液負荷

循環血液量減少が明らかであるか疑われる場合：

1. 500-1,000mLの晶質液 or 300-500mLの膠質液を30分かけて投与
2. 初期蘇生の目標値に達するまで、または輸液過多寸前になるまで1)を行う。

昇圧薬(ICU.646)

1. 輸液負荷を行っても低血圧が持続する場合、ドパミン or ノルアドレナリンを投与

ドパミン：5-20 ug/kg/min：心拍出量増加：腹腔内蔵機の血流減少

ノルアドレナリン：0.2-1.3 ug/kg/min：心拍出量不変、血管収縮

2. 1. に不応の場合、パソプレシン

パソプレシン：0.01-0.04 U/min：血管収縮薬：心拍出量減少→心不全の既往で慎重

経験的抗菌薬治療(ICU.646)

重症敗血症や敗血症性ショックと診断したら1時間以内に抗菌薬を静脈内投与する
抗菌薬投与前に少なくとも2セットの血液検体を採取　→　血液培養＆感受性検査のため
イミペネム/メロペネムの単剤
MRSAのリスクリスク有り：イミペネム/メロペネム + バンコマイシン/リネゾリド

コルチコステロイド(ICU.646)

昇庄薬を必要とするすべての敗血症性ショック患者に推奨
ヒドロコルチゾン：200-300mg用を2-3回に分割して静脈内投与もしくは経口投与、7日間継続
副腎不全の改善

「全身性炎症反応症候群」

　　[★]

英: systemic inflammatory response syndrome, SIRS
関: 敗血症、菌血症

概念

病態により定義される症候群
感染症の有無に限らず全身的に炎症性メディエーターが産生される病態

症状

発熱、頻脈、白血球増多、呼吸数増加が診断基準

診断基準

バイタルサインのうち「体温(炎症の程度を表現)とrateを表すHRとRRが含まれる」と覚えておくか。

下記項目のうち2項目以上が当てはまる

1. 体温>38℃ or 体温<36℃
2. 心拍数>90bpm
3. 呼吸数>20回/min or PaCO2<32mmHg
4. (白血球数>12,000/ul or 白血球数<4,000/ul) or ( 幼若好中球>10% )　←　~~ここでいう幼若好中球とは桿状好中球のことである。(出典不明)~~