遅発性神経脱落症候の予測におけるSIRSの臨床的意義

Abstract

Systemic inflammatory response syndrome (SIRS) is the clinical expression of the action of complex intrinsic mediators of the acute phase reaction, and is a warning sign of multiple organ dysfunction syndrome (MODS) and poor outcome in various insults. Subarachnoid hemorrhage (SAH) also causes an inflammatory reaction and may lead to ischemic damage. We studied the predictive value of the SIRS for the occurrence of symptomatic vasospasms in 101 patients with aneurysmal subarachnoid hemorrhage.The patients were classified into three groups, according to the continuance of SIRS as follows: Group A (the presence of SIRS on admission/the presence of SIRS at the postoperative first day: SIRS+/+), Group B (SIRS+1 or SIRS -/+) and Group C (SIRS-/-). The correlation between the status of SIRS and the development of delayed ischemic neurological deficits was analyzed. Twenty-nine (28.7%) patients met the criteria for SIRS on admission. Postoperatively, 22 (21.8%) patients developed SIRS. Ten (10.0%) patients were assigned to Group A, 31 (30.7%) to Group B, and 60 (59.3%) to Group C. Thirty-five (33.6%) of the patients developed DIND. The incidence of DINDs was 90% (9/10) in Group A, and 35.5% (11 of 31) in Group B, and 25.0% (15 of 60) in Group C. There was a significant difference between the three groups. In addition, the outcome was significantly related to the presence of SIRS. The present study shows that sustained SIRS has a predictive value regarding the occurrence of symptomatic vasospasm following aneurysmal surgery.