拯救脓毒症新理念:从现象到本质

New Concept for Surviving Sepsis:from Phenomenon to Essence

脓毒症是困扰重症医学界多年的临床综合征,近年国际上的几项大型研究对脓毒症治疗中的重要措施——早期目标导向治疗(early goal directed therapy,EGDT)方案提出质疑,脓毒症指南工作组对原有的集束化治疗(Bundle)也进行了修定,其本质在于强调通过多种方法实现对患者器官功能的全面评估,通过多元的措施达到监测与指导治疗的目的。随着对脓毒症发病机制的不断研究,大家已认识到脓毒症的核心机制并不能简单归咎于全身炎症反应,而是机体对抗感染的反应失调而引起的危及生命的器官功能损害,这促使了脓毒症定义的更新。脓毒症新定义将器官功能放到核心的位置,并强调了动态监测的重要性,对未来的临床与科研工作具有新的指导意义。关注多种监测方法的进展,并开展相应的临床和基础研究,才能为患者提供更好的综合治疗,达到改善患者生存和预后的目的。

Sepsis is a critical clinical syndrome which keep puzzling the medical profession for many years.Recently,the results from several large-scale trials challenged the necessity of early goal directed therapy（EGDT）in surviving sepsis bundle,These trials were not opposed to EGDT but bring new concept that it is essential to utilize therapy with multiple monitoring measures in order to minimize injury while guarantee the safety.Deeper understanding in the pathogenesis of sepsis gives rise to the update of its definition based on vital organ dysfunction.The importance of dynamic monitoring in defining sepsis also need to be emphasized.Developing more effective monitoring measures could provide better treatments,thus improve the prognosis of septic patients.