Carvalho Paulo R A, Trotta Eliana de A
Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
J Pediatr (Rio J). 2003 Nov;79 Suppl 2:S195-204. doi: 10.2223/jped.1096.
To present a critical and updated review about sepsis, focusing especially on diagnosis and treatment.
Literature review of Medline, including review articles, clinical trials and original research.
The International Sepsis Definitions Conference amplified the list of possible clinical and laboratory signs of sepsis, which may allow for more efficacious suspicion and management. In terms of laboratory evaluation, in addition to the research for infectious agents, many inflammatory response markers, such as inflammatory cytokines and procalcitonin, have been identified. However, they lack sensitivity and specificity for safe diagnosis. In terms of treatment, early intervention to prevent hemodynamic disturbances is still essential for a positive outcome, together with the appropriate use of antimicrobials. The value of treatments to remove toxins and to increase the innate immune response has not yet been established. The use of isolated inflammatory response blockers, at any stage of sepsis, does not decrease mortality. The use of corticosteroid makes a comeback with encouraging results, even in patients without sepsis-related adrenal insufficiency. A large study on activated protein C (drotrecogin-alpha ) reports a 6% decrease in mortality in a selected sample, suggesting the possibility of a better prognosis for sepsis patients.
In comparison to the advances of the past few years, little has been achieved in terms of decreasing sepsis-related mortality due to the complexity of the pathogen-host relationships. The individual regulation of host reactions did not have the expected effects. The benefits of some known strategies were confirmed. Other types of treatment, such as corticosteroids and activated protein C therapies, are emerging as promising alternatives. Research indicates that the combination of immune modulator therapies is probably the best choice to improve outcomes in sepsis.
对脓毒症进行批判性的最新综述，尤其关注诊断和治疗。
对Medline的文献综述，包括综述文章、临床试验和原创研究。
国际脓毒症定义会议扩充了脓毒症可能的临床和实验室体征清单，这可能有助于更有效地进行怀疑和管理。在实验室评估方面，除了寻找感染病原体外，还确定了许多炎症反应标志物，如炎症细胞因子和降钙素原。然而，它们在安全诊断方面缺乏敏感性和特异性。在治疗方面，早期干预以预防血流动力学紊乱对于取得良好结局仍然至关重要，同时要合理使用抗菌药物。去除毒素和增强先天免疫反应的治疗价值尚未确定。在脓毒症的任何阶段使用单独的炎症反应阻滞剂并不能降低死亡率。皮质类固醇的使用再度出现且结果令人鼓舞，即使在没有脓毒症相关肾上腺功能不全的患者中也是如此。一项关于活化蛋白C（重组人活化蛋白C）的大型研究报告称，在选定样本中死亡率降低了6%，这表明脓毒症患者可能有更好的预后。
与过去几年的进展相比，由于病原体与宿主关系的复杂性，在降低脓毒症相关死亡率方面进展甚微。宿主反应的个体调节并未产生预期效果。一些已知策略的益处得到了证实。其他类型的治疗，如皮质类固醇和活化蛋白C疗法，正作为有前景的替代方案出现。研究表明，免疫调节疗法的联合使用可能是改善脓毒症结局的最佳选择。
