重症感染的早期诊断和治疗

Early diagnosis and treatment of severe sepsis

重症感染是全身性感染导致的以器官功能损害为特征的临床综合征。由于重症感染起病时临床表现缺乏特异性,早期诊断需要结合临床表现、实验室检查和微循环的监测,参考生物标志物,不但有助于指导重症感染的早期诊断和抗生素的选择,并且有助于判断患者预后。重症感染治疗的重点在于积极治疗原发病,加强感染部位引流的同时,早期应用有效的抗生素治疗,进行早期目标导向的积极液体复苏,并且给予血管活性药物和调整心脏功能,以改善和维持组织灌注,保护其他器官的功能。

Severe sepsis is a disaster syndrome, which is defined as sepsis with organ dysfunction. Since clinical manifestations of severe sepsis lack specificity, early diagnosis needs to combine clinical manifestations, laboratory tests and microcirculation monito- ring. Biomarkers are not only help early diagnosis and antibiotic selection, but also have prognostic value. The key of treatment of severe sepsis is to cure the primary disease and strengthen infection site drainage. At the same time, it also needs early application of effective antibiotic therapy,early goal-directed fluid resuscitation and administration of vasoactive drug treatment to improve cardiac function. Thus,the tissue perfusion could be improved and functions of other organs could be protected. As results, the mortality may be de- creased.