早期识别脓毒症、严重脓毒症及脓毒性休克

Sepsis, severe sepsis and septic shock： the importance of early recognition

早期识别严重脓毒症和脓毒性休克,及早启动有效干预,实施早期目标导向治疗是降低其病死率、改善预后的关键.本文重点介绍脓毒症分阶段诊断系统（即PIRO分级系统）、系统的预警及快速反应系统等临床识别方法;多种生物学标记物及蛋白质组学和代谢组学在脓毒症和严重脓毒症诊断中的价值.目前尚无单一完美的指标可以早期识别脓毒症,因此,临床医生更应该结合患者症状、体征和生物学标记物综合判断,动态观察监测参数变化,从而做出合理的判断和决策.

Early recognition of severe sepsis and septic shock, early initiation of effective interven- tions, implementation of early goal-directed therapy may be key approaches for reducing the mortality and im- proving the prognosis. This article focused on the staging diagnosis systems for sepsis （ PIRO sepsis classifi- cation system） and the systematic early warning or rapid response system. We also discussed the diagnostic value of biomarkers ,proteomics and metabolomics in sepsis and severe sepsis. No single marker as ＂golden standard＂ has emerged that can provide clinicians with all the information they need for early recognition of sepsis. Therefore, we suggested that clinicians should have even more reason to combine the sepsis symp- toms, signs and biomarkers for a comprehensive evaluation, and that they needed to dynamically monitor the changes in these parameters, in order to make reasonable clinical decisions and strategies.