Also known as SIRS, the systemic inflammatory response syndrome is a pathological condition, the occurrence of which is associated with increased risks of serious consequences for the patient's body. SVERS is possible against the background of surgical measures, which are currently extremely widespread, in particular when it comes to malignant pathologies. Otherwise, in addition to the operation, the patient cannot be cured, but the intervention can provoke CVD.
Question Features
Since the syndrome of a systemic inflammatory response in surgery more often occurs in patients who were prescribed treatment against a background of general weakness, illness, the likelihood of a severe course is caused by side effects of other therapeutic methods used in a particular case. Regardless of where exactly the injury caused by the operation is located, the early rehabilitation period is associated with increased risks of secondary damage.
As is known from pathological anatomy, the syndrome of a systemic inflammatory response is also due to the fact that any operation provokes acute inflammation. The severity of such a reaction is determined by the severity of the transferred event, a number of auxiliary phenomena. The more unfavorable the background of the operation, the more difficult the BSSO will be.
What and how?
Syndrome of a systemic inflammatory response is a pathological condition that indicates tachypnea, fever, impaired rhythm of the heartbeat. Tests show leukocytosis. In many ways, this response of the body is due to the characteristic activity of cytokines. The pro-inflammatory cell structures that explain CVD and sepsis form the so-called secondary wave of mediators, due to which systemic inflammation does not subside. This is associated with the danger of hypercytokinemia, a pathological condition in which damage is caused to tissues, organs of your own body.
The problem of determining and predicting the likelihood of a systemic inflammatory response syndrome, in ICD-10, encrypted with R65, in the absence of a suitable method for assessing the patient's initial state. There are several options and gradations that allow you to determine how poor the patient’s health is, but not one of them is linked to the risks of CVD. Take into account that in the first 24 hours after the intervention, the CVD appears without fail, but the intensity of the condition varies - this is determined by a complex of factors. If the phenomenon is severe, prolonged, the likelihood of complications, pneumonia increases.
About terms and theory
Syndrome of a systemic inflammatory response, encoded as R65 in ICD-10, was considered in 1991 at a conference that brought together leading experts in the field of intensive care and pulmonology. It was decided to recognize the CVD as a key aspect reflecting any inflammatory process of an infectious nature. Such a systemic reaction is associated with the active distribution of cytokines, and it is not possible to take this process under control by the forces of the body. Inflammatory mediators are generated in the primary focus of infection, from where they move into the tissues around, thus entering the circulatory system. The processes proceed with the involvement of macrophages, activators. Other tissues of the body, remote from the primary focus, become the area of generation of similar substances.
According to the pathophysiology of the syndrome of a systemic inflammatory response, histamine most often acts as an inflammatory mediator . Platelet activating factors, as well as those associated with necrotic tumor processes, have similar effects. The participation of adhesive molecular structures of the cell, parts of complement, nitric oxides is possible. CERD can be explained by the activity of toxic products of oxygen transformation and peroxidation of fatty oxidation.
Pathogenesis
The syndrome of systemic inflammatory response, fixed by the R65 code in ICD-10, is observed when a person’s immunity cannot take control and extinguish the active systemic spread of factors initiating inflammatory processes. There is an increase in the content of mediators in the circulatory system, which leads to a failure of the microcirculation of the fluid. The capillary endothelium becomes more permeable, poisonous components from the channel penetrate through the gaps of this tissue into the surrounding vessels of the cell. Over time, inflamed foci distant from the primary region appear, and gradually progressive insufficiency of various internal structures is observed. As a result of this process - DIC syndrome, immunity paralysis, lack of functioning in a multi-organ form.
As shown by numerous studies on the occurrence of a systemic inflammatory response syndrome in obstetrics, surgery, oncology, such a response appears both when an infectious agent enters the body and as a response to a certain stress factor. SARS can trigger somatic pathology or personal injury. In some cases, the root cause is an allergic reaction to the medication, ischemia of certain parts of the body. To some extent, NERC is such a universal response of the human body to unhealthy processes occurring in it.
Subtleties of the question
Studying the systemic inflammatory response syndrome in obstetrics, surgery, and other branches of medicine, scientists paid special attention to the rules for determining this condition, as well as to the intricacies of using different terminology. In particular, it makes sense to talk about sepsis if the cause of inflammation in a systemic form becomes an infectious focus. In addition, sepsis is observed if the functioning of some parts of the body is disrupted. Sepsis can be diagnosed only with the obligatory allocation of both signs: SSVR, infection of the body.
If manifestations are observed that make it possible to suspect dysfunction of internal organs and systems, that is, the reaction has spread wider than the primary focus, a severe variant of the course of sepsis is revealed. When choosing a treatment, it is important to remember the possibility of transistor bacteremia, which does not lead to a generalization of the infectious process. If this has caused CERD, organ dysfunction, it is necessary to choose the therapeutic course indicated for sepsis.
Categories and severity
Focusing on the diagnostic criteria of the systemic inflammatory response syndrome, it is customary to distinguish four forms of the condition. The key features that allow us to talk about NEED:
- heat above 38 degrees or a temperature less than 36 degrees;
- the heart contracts with a frequency of more than 90 acts per minute;
- frequency respiration exceeds 20 acts per minute;
- with mechanical ventilation 2 less than 32 units;
- leukocytes in the analysis are defined as 12 * 10 ^ 9 units;
- leukopenia 4 * 10 ^ 9 units;
- new leukocyte forms more than 10% of the total.
To diagnose CVD, the patient must have two of these symptoms or more.
About options
If the patient has two or more signs of the above manifestations of the systemic inflammatory response syndrome, and the studies show the infection, the analysis of blood samples gives an idea of the causative agent that caused the condition, diagnose sepsis.
In case of insufficiency developing according to the multi-organ scenario, with acute failures in the status of the patient's psyche, lactic acidosis, oliguria, pathologically severely reduced blood pressure in the arteries, a severe form of sepsis is diagnosed. The condition can be maintained through intensive therapeutic approaches.
Septic shock is detected if sepsis develops in a severe form, low blood pressure is observed in a persistent form, perfusion failures are stable and cannot be controlled by classical methods. In CVD, hypotension is considered a condition in which the pressure is less than 90 units or less than 40 units relative to the initial state of the patient, when there are no other factors that can provoke a decrease in the parameter. It is taken into account that taking certain medications may be accompanied by manifestations indicating organ dysfunction, perfusion problem, while the pressure is maintained adequate.
Could it be worse?
The most severe variant of the course of the systemic inflammatory response syndrome is observed if the patient disrupts the functionality of a couple or more organs necessary to maintain viability. This condition is called multiple organ failure syndrome. This is possible if CVD is very difficult, while medication and instrumental methods do not allow you to control and stabilize homeostasis, with the exception of methods and techniques of intensive treatment.
Development concept
At present, a two-phase concept is known in medicine that describes the development of SIRS. The base of the pathological process becomes a cascade of cytokines. At the same time, initiating inflammatory processes of cytokines are activated, and with them, mediators that inhibit the activity of the inflammatory process. In many ways, how the syndrome of a systemic inflammatory response will proceed and develop is determined precisely by the balance of these two components of the process.
CERE progresses in stages. The first in science is called induction. This is the period during which the focus of inflammation is local, due to a normal organic reaction to the influence of some aggressive factor. The second stage is cascading, in which too many inflammatory mediators are generated in the body that can penetrate the circulatory system. At the third stage, there is a secondary aggression directed at one's own cells. This explains the typical picture of the course of the syndrome of a systemic inflammatory response, early manifestations of insufficient organ functionality.
The fourth stage is immunological paralysis. At this developmental stage, a deeply depressed state of immunity is observed, the work of organs is very disturbed. The fifth, final stage is the terminal.
Can something help?
If it is necessary to alleviate the course of the systemic inflammatory response syndrome, the clinical recommendation is to monitor the patient’s condition by regularly taking vital signs and using medications. If necessary, the patient is connected to special equipment. Recently, medications created specifically for stopping CVD in its various manifestations have looked especially promising.
Drugs effective for SSBO are based on diphosphopyridine nucleotide and also include inosine. In some embodiments, release contain digoxin, lisinopril. Combined medications, selected at the discretion of the attending doctor, inhibit CVD, regardless of what caused the pathological process. Manufacturers assure that a pronounced effect can be achieved in the shortest possible time.
Is an operation necessary?
With CVD, additional surgery may be prescribed. Its necessity is determined by the severity of the condition, its course and development forecasts. As a rule, it is possible to carry out organ-sparing intervention, during which the suppuration area is drained.
About drugs in more detail
The identification of the medicinal characteristics of diphosphopyridine nucleotide combined with inosine gave doctors new opportunities. Such a medicine, as practice has shown, is applicable in the work of cardiologists and nephrologists, surgeons and pulmonologists. Preparations with this composition are used by anesthetists, gynecologists, endocrinologists. Currently, drugs are used in surgical operations on the heart and blood vessels, and if necessary, provide assistance to the patient in the intensive care unit.
Such a wide area of use is associated with the general symptoms of sepsis, the effects of burns, manifestations of diabetes occurring in a decompensated handicap, shock against the background of trauma, SDS, pancreatic necrotic processes and many other serious pathological uprisings. The symptom complex characteristic of CVD and effectively stopped by diphosphopyridine nucleotide in combination with inosine includes weakness, soreness, and sleep disturbances. The drug relieves the condition of a patient who has a headache and dizziness, symptoms of encephalopathy appear, the skin turns pale or yellow, the rhythm and heart rate are disturbed, blood flow interruptions occur.
Relevance of the issue
As statistical studies have shown, CVD is currently one of the most common options for the development of severe hypoxia, strong destructive activity of individual tissue cells. In addition, such a syndrome with a high degree of probability develops against a background of chronic intoxication. The pathogenesis and etiology of the conditions leading to CVD are very different.
With any shock, there is necessarily a NEER. The reaction becomes one of the aspects of sepsis, a pathological condition caused by trauma or burns. It cannot be avoided if a person has had a TBI or surgery. As observations have shown, CVD is diagnosed in patients with diseases of the bronchi, lungs, with uremia, oncology, and surgical pathological conditions. It is impossible to exclude CVD if an inflammatory or necrotic process develops in the pancreas or abdominal cavity.
As specific studies have shown, CVD is also observed in a number of more favorably developing diseases. As a rule, with them this condition does not threaten the patient's life, but lowers its quality. We are talking about a heart attack, ischemia, hypertension, gestosis, burns, osteoarthrosis.