Sepsis不同于感染,是机体对感染的反应失控而导致的危及生命的器官功能障碍。Sepsis的重点在于器官功能障碍而非感染,这可能是美国感染病学会(Infectious Disease Society of America,IDSA)与"拯救Sepsis运动(Surviving Sepsis Cam...Sepsis不同于感染,是机体对感染的反应失控而导致的危及生命的器官功能障碍。Sepsis的重点在于器官功能障碍而非感染,这可能是美国感染病学会(Infectious Disease Society of America,IDSA)与"拯救Sepsis运动(Surviving Sepsis Campaign,SSC)"在重症感染认知上的分歧。对于Sepsis而言,筛查至关重要,可更早地启动集束性治疗策略,从而改善患者预后。Sepsis的理念来源于循证医学证据及大数据研究结果,二者奠定了其坚实的理论基础。本文根据IDSA提出的争议话题,从SSC角度,阐述重症医学对Sepsis本质的认知。展开更多
Background Surviving sepsis campaign （SSC） bundles have been demonstrated to significantly improve survival in sepsis and septic shock patients worldwide. Compliance with these protocols and resultant mortality in s...Background Surviving sepsis campaign （SSC） bundles have been demonstrated to significantly improve survival in sepsis and septic shock patients worldwide. Compliance with these protocols and resultant mortality in sepsis patients was investigated in intensive care units （ICUs） in China. Methods Adult patients with severe sepsis or septic shock treated from September 2007 to October 2008 in 11 ICUs of Chinese teaching hospitals were included. The primary outcome was compliance with resuscitation and management bundles. Secondary outcomes included individual bundle protocol impact and the effects of the completed bundle protocol number on 28-day mortality. Results Overall compliance during 6-hr resuscitation and 24-hour management bundles were 5.5% and 17.4%, respectively, and 28-day mortality was 33.0%. Compliance with protocols for blood cultures before antibiotics （42.2%）, central venous pressure 〉8 mmHg （65.9%）, central venous oxygen saturation 〉70% （25.0%）, and optimized glucose control （82.1%）, were significantly associated with decreased 28-day mortality （P 〈0.05）. When adjusted for age, acute organ dysfunction, and APACHE II score, compliance with the blood culture before antibiotics protocol produced the most significant decrease in 28-day mortality （OR, 0.33; 95% CI, 0.16-0.70; P=0.004）. Compliance with z5 protocols in the 6-hour resuscitation bundle was also associated with lower 28-day mortality in septic shock patients （OR, 0.17; 95% CI, 0.06-0.54; P = 0.001）. Conclusions Compliance with resuscitation and management bundles is generally poor in China; however, when applied, 6-hour resuscitation bundle are associated with significant reductions in 28-day mortality for sepsis patients.展开更多
国际专家组对“拯救脓毒症运动：2012版脓毒症和脓毒性休克管理指南”进行了更新，结果发表于Critical Care Medicme杂志。新版指南在循证证据的基础上提出了一些新的推荐意见，指南最大的变化是初始复苏策略及抗生素的应用。本文重点...国际专家组对“拯救脓毒症运动：2012版脓毒症和脓毒性休克管理指南”进行了更新，结果发表于Critical Care Medicme杂志。新版指南在循证证据的基础上提出了一些新的推荐意见，指南最大的变化是初始复苏策略及抗生素的应用。本文重点就主要的变化以及变化的依据做一解读。展开更多
文摘Sepsis不同于感染,是机体对感染的反应失控而导致的危及生命的器官功能障碍。Sepsis的重点在于器官功能障碍而非感染,这可能是美国感染病学会(Infectious Disease Society of America,IDSA)与"拯救Sepsis运动(Surviving Sepsis Campaign,SSC)"在重症感染认知上的分歧。对于Sepsis而言,筛查至关重要,可更早地启动集束性治疗策略,从而改善患者预后。Sepsis的理念来源于循证医学证据及大数据研究结果,二者奠定了其坚实的理论基础。本文根据IDSA提出的争议话题,从SSC角度,阐述重症医学对Sepsis本质的认知。
文摘Background Surviving sepsis campaign （SSC） bundles have been demonstrated to significantly improve survival in sepsis and septic shock patients worldwide. Compliance with these protocols and resultant mortality in sepsis patients was investigated in intensive care units （ICUs） in China. Methods Adult patients with severe sepsis or septic shock treated from September 2007 to October 2008 in 11 ICUs of Chinese teaching hospitals were included. The primary outcome was compliance with resuscitation and management bundles. Secondary outcomes included individual bundle protocol impact and the effects of the completed bundle protocol number on 28-day mortality. Results Overall compliance during 6-hr resuscitation and 24-hour management bundles were 5.5% and 17.4%, respectively, and 28-day mortality was 33.0%. Compliance with protocols for blood cultures before antibiotics （42.2%）, central venous pressure 〉8 mmHg （65.9%）, central venous oxygen saturation 〉70% （25.0%）, and optimized glucose control （82.1%）, were significantly associated with decreased 28-day mortality （P 〈0.05）. When adjusted for age, acute organ dysfunction, and APACHE II score, compliance with the blood culture before antibiotics protocol produced the most significant decrease in 28-day mortality （OR, 0.33; 95% CI, 0.16-0.70; P=0.004）. Compliance with z5 protocols in the 6-hour resuscitation bundle was also associated with lower 28-day mortality in septic shock patients （OR, 0.17; 95% CI, 0.06-0.54; P = 0.001）. Conclusions Compliance with resuscitation and management bundles is generally poor in China; however, when applied, 6-hour resuscitation bundle are associated with significant reductions in 28-day mortality for sepsis patients.
文摘Sepsis是导致重症患者死亡的重要原因。近年来,随着临床和基础研究的不断发展,人们对于Sepsis定义、诊断以及治疗认识不断深入,患者病死率持续下降。每4年颁布一次并更新的"拯救Sepsis运动(Surviving Sepsis Campaign,SSC)"指南受到国际广泛重视。2016年版SSC指南,在对Sepsis和感染性休克重新定义、重新制定诊断标准的基础上,于2017年1月正式发布。然而,2017年11月,美国感染病学会(Infectious Disease Society of America,IDSA)即在其官方期刊Clin Infect Dis发表公开声明,对2016年版SSC指南中关于感染诊疗的推荐意见提出质疑。本文站在IDSA的立场,尝试从Sepsis概念、诊断及治疗3个方面解读IDSA声明,探讨Sepsis中的"感染"问题。
