脓毒症的诊断和治疗进展
Advances in the Diagnosis and Treatment of Sepsis
DOI: 10.12677/acm.2025.1551646, PDF,   
作者: 刘 慧, 钟彦菊:浙江康静医院重症医学科,浙江 杭州
关键词: 脓毒症诊断治疗结局Sepsis Diagnosis Treatment Outcome
摘要: 脓毒症是严重感染的一种并发症,其特征是全身炎症反应。严重脓毒症的脓毒症死亡率为25%~30%,脓毒性休克的死亡率为40%~70%。脓毒症仍然是全球死亡的主要原因之一。自1991年建立第一个共识定义以来,其发病率有所增加。提高脓毒症的认识、其重要性和对更好治疗的需求,导致了脓毒症定义和治疗指南的制定的改进。本文将介绍脓毒症和脓毒性休克的既往和新定义、既往识别和治疗指南以及最新的治疗建议。及时诊断对于脓毒症和脓毒性休克患者的结局至关重要。在识别脓毒症后的前6小时内完成早期目标导向治疗可显著降低院内死亡率。及时启动循证方案应可改善脓毒症结局。
Abstract: Sepsis is a complication of severe infection characterized by systemic inflammatory response. The mortality rate of severe sepsis is 25%~30%, and that of septic shock is 40%~70%. Sepsis remains one of the leading causes of death worldwide. Since the establishment of the first consensus definition in 1991, its incidence has increased. The improvement of awareness of sepsis, its importance, and the need for better treatment has led to the refinement of sepsis definitions and treatment guidelines. This article will introduce the past and new definitions of sepsis and septic shock, past identification and treatment guidelines, as well as the latest treatment recommendations. Timely diagnosis is crucial for the outcome of patients with sepsis and septic shock. Completing early goal-directed therapy within the first 6 hours after identifying sepsis can significantly reduce in-hospital mortality. Timely initiation of evidence-based protocols should improve sepsis outcomes.
文章引用:刘慧, 钟彦菊. 脓毒症的诊断和治疗进展[J]. 临床医学进展, 2025, 15(5): 2521-2526. https://doi.org/10.12677/acm.2025.1551646

参考文献

[1] Srzić, I., Nesek Adam, V. and Tunjić Pejak, D. (2022) Sepsis Definition: What’s New in the Treatment Guidelines. Acta Clinica Croatica, 61, 67-72.
[2] He, Y., Xu, J., Shang, X., Fang, X., Gao, C., Sun, D., et al. (2022) Clinical Characteristics and Risk Factors Associated with ICU-Acquired Infections in Sepsis: A Retrospective Cohort Study. Frontiers in Cellular and Infection Microbiology, 12, Article 962470. [Google Scholar] [CrossRef] [PubMed]
[3] Plaeke, P., De Man, J.G., Coenen, S., Jorens, P.G., De Winter, B.Y. and Hubens, G. (2019) Clinical-and Surgery-Specific Risk Factors for Post-Operative Sepsis: A Systematic Review and Meta-Analysis of over 30 Million Patients. Surgery Today, 50, 427-439. [Google Scholar] [CrossRef] [PubMed]
[4] Yang, W.S., Kim, Y., Ryoo, S.M. and Kim, W.Y. (2021) Independent Risk Factors for Sepsis-Associated Cardiac Arrest in Patients with Septic Shock. International Journal of Environmental Research and Public Health, 18, Article 4971. [Google Scholar] [CrossRef] [PubMed]
[5] Godínez-Vidal, A.R., Alcántara-Gordillo, R., Aguirre-Rojano, V.I., López-Romero, S.C., González-Calatayud, M., González-Pérez, L.G., et al. (2020) Evaluación de la proteína C reactiva, la procalcitonina y el índice PCR/PCT como indicadores de mortalidad en sepsis abdominal. Cirugía y Cirujanos, 88, 150-153. [Google Scholar] [CrossRef] [PubMed]
[6] Swenson, K.E., Dziura, J.D., Aydin, A., Reynolds, J. and Wira, C.R. (2017) Evaluation of a Novel 5-Group Classification System of Sepsis by Vasopressor Use and Initial Serum Lactate in the Emergency Department. Internal and Emergency Medicine, 13, 257-268. [Google Scholar] [CrossRef] [PubMed]
[7] Moriyama, K., Ando, T., Kotani, M., Tokumine, J., Nakazawa, H., Motoyasu, A., et al. (2022) Risk Factors Associated with Increased Incidences of Catheter-Related Bloodstream Infection. Medicine, 101, e31160. [Google Scholar] [CrossRef] [PubMed]
[8] Ren, Y., Zhang, L., Xu, F., Han, D., Zheng, S., Zhang, F., et al. (2022) Risk Factor Analysis and Nomogram for Predicting In-Hospital Mortality in ICU Patients with Sepsis and Lung Infection. BMC Pulmonary Medicine, 22, Article No. 17. [Google Scholar] [CrossRef] [PubMed]
[9] Vickers, A.J. and Elkin, E.B. (2006) Decision Curve Analysis: A Novel Method for Evaluating Prediction Models. Medical Decision Making, 26, 565-574. [Google Scholar] [CrossRef] [PubMed]
[10] Siore, A.M., Parker, R.E., Stecenko, A.A., Cuppels, C., McKean, M., Christman, B.W., et al. (2005) Endotoxin-induced Acute Lung Injury Requires Interaction with the Liver. American Journal of Physiology-Lung Cellular and Molecular Physiology, 289, L769-L776. [Google Scholar] [CrossRef] [PubMed]
[11] Singer, M., Deutschman, C.S., Seymour, C.W., Shankar-Hari, M., Annane, D., Bauer, M., et al. (2016) The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315, 801-810. [Google Scholar] [CrossRef] [PubMed]
[12] Kraut, J.A. and Madias, N.E. (2014) Lactic Acidosis. New England Journal of Medicine, 371, 2309-2319. [Google Scholar] [CrossRef] [PubMed]
[13] Cecconi, M., De Backer, D., Antonelli, M., Beale, R., Bakker, J., Hofer, C., et al. (2014) Consensus on Circulatory Shock and Hemodynamic Monitoring. Task Force of the European Society of Intensive Care Medicine. Intensive Care Medicine, 40, 1795-1815. [Google Scholar] [CrossRef] [PubMed]
[14] Wang, H.E., Shapiro, N.I., Griffin, R., Safford, M.M., Judd, S. and Howard, G. (2012) Chronic Medical Conditions and Risk of Sepsis. PLOS ONE, 7, e48307. [Google Scholar] [CrossRef] [PubMed]
[15] Frydrych, L.M., Fattahi, F., He, K., Ward, P.A. and Delano, M.J. (2017) Diabetes and Sepsis: Risk, Recurrence, and Ruination. Frontiers in Endocrinology, 8, Article 271. [Google Scholar] [CrossRef] [PubMed]
[16] Walker, A.M.N., Drozd, M., Hall, M., Patel, P.A., Paton, M., Lowry, J., et al. (2018) Prevalence and Predictors of Sepsis Death in Patients with Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction. Journal of the American Heart Association, 7, e009684. [Google Scholar] [CrossRef] [PubMed]
[17] Moss, M. (2005) Epidemiology of Sepsis: Race, Sex, and Chronic Alcohol Abuse. Clinical Infectious Diseases, 41, S490-S497. [Google Scholar] [CrossRef] [PubMed]
[18] Trevejo-Nunez, G., Kolls, J.K. and de Wit, M. (2015) Alcohol Use as a Risk Factor in Infections and Healing: A Clinician’s Perspective. Alcohol Research, 37, 177-184.
[19] Eisenstein, T.K. (2019) The Role of Opioid Receptors in Immune System Function. Frontiers in Immunology, 10, Article 2904. [Google Scholar] [CrossRef] [PubMed]
[20] Alrawashdeh, M., Klompas, M., Kimmel, S., Larochelle, M., Septimus, E., Kadri, S., et al. (2020) 56: Epidemiology, Outcomes, and Trends of Sepsis in Patients with Opioid Use Disorders in U.S. Hospitals. Critical Care Medicine, 48, 28-28. [Google Scholar] [CrossRef
[21] Koch, K., Sogaard, M., Norgaard, M., Thomsen, R.W. and Schonheyder, H.C. (2014) Socioeconomic Inequalities in Risk of Hospitalization for Community-Acquired Bacteremia: A Danish Population-Based Case-Control Study. American Journal of Epidemiology, 179, 1096-1106. [Google Scholar] [CrossRef] [PubMed]
[22] Tang, A., Shi, Y., Dong, Q., Wang, S., Ge, Y., Wang, C., et al. (2023) Prognostic Differences in Sepsis Caused by Gram-Negative Bacteria and Gram-Positive Bacteria: A Systematic Review and Meta-Analysis. Critical Care, 27, Article No. 467. [Google Scholar] [CrossRef] [PubMed]
[23] Horn, D.L., Morrison, D.C., Opal, S.M., Silverstein, R., Visvanathan, K. and Zabriskie, J.B. (2000) What Are the Microbial Components Implicated in the Pathogenesis of Sepsis? Report on a Symposium. Clinical Infectious Diseases, 31, 851-858. [Google Scholar] [CrossRef] [PubMed]
[24] Sriskandan, S. and Cohen, J. (1999) GRAM-POSITIVE Sepsis. Infectious Disease Clinics of North America, 13, 397-412. [Google Scholar] [CrossRef] [PubMed]
[25] Parrillo, J.E., Parker, M.M., Natanson, C., Suffredini, A.F., Danner, R.L., Cunnion, R.E., et al. (1990) Septic Shock in Humans. Annals of Internal Medicine, 113, 227-242. [Google Scholar] [CrossRef] [PubMed]
[26] Wang, J.E., Dahle, M.K., McDonald, M., Foster, S.J., Aasen, A.O. and Thiemermann, C. (2003) Peptidoglycan and Lipoteichoic Acid in Gram-Positive Bacterial Sepsis: Receptors, Signal Transduction, Biological Effects, and Synergism. Shock, 20, 402-414. [Google Scholar] [CrossRef] [PubMed]
[27] Abe, R., Oda, S., Sadahiro, T., Nakamura, M., Hirayama, Y., Tateishi, Y., et al. (2010) Gram-Negative Bacteremia Induces Greater Magnitude of Inflammatory Response than Gram-Positive Bacteremia. Critical Care, 14, Article No. R27. [Google Scholar] [CrossRef] [PubMed]
[28] León, C., Rodrigo, M.J., Tomasa, A., Gallart, M.T., Latorre, F.J., Rius, J., et al. (1982) Complement Activation in Septic Shock Due to Gram-Negative and Gram-Positive Bacteria. Critical Care Medicine, 10, 305-307. [Google Scholar] [CrossRef
[29] Jang, D., Jo, Y.H., Lee, J.H., Kim, J., Park, S.M., Hwang, J.E., et al. (2020) Moderate to Severe Hyperphosphataemia as an Independent Prognostic Factor for 28-Day Mortality in Adult Patients with Sepsis. Emergency Medicine Journal, 37, 355-361. [Google Scholar] [CrossRef] [PubMed]
[30] Zhao, L., Zhao, L., Wang, Y.y., Yang, F., Chen, Z., Yu, Q., et al. (2020) Platelets as a Prognostic Marker for Sepsis: A Cohort Study from the MIMIC-III Database. Medicine, 99, e23151. [Google Scholar] [CrossRef] [PubMed]