Nguyen H Bryant, Rivers Emanuel P, Abrahamian Fredrick M, Moran Gregory J, Abraham Edward, Trzeciak Stephen, Huang David T, Osborn Tiffany, Stevens Dennis, Talan David A
Loma Linda University, Loma Linda, CA, USA.
Ann Emerg Med. 2006 Jul;48(1):28-54. doi: 10.1016/j.annemergmed.2006.02.015. Epub 2006 May 2.
Severe sepsis and septic shock are as common and lethal as other acute life-threatening conditions that emergency physicians routinely confront such as acute myocardial infarction, stroke, and trauma. Recent studies have led to a better understanding of the pathogenic mechanisms and the development of new or newly applied therapies. These therapies place early and aggressive management of severe sepsis and septic shock as integral to improving outcome. This independent review of the literature examines the recent pathogenic, diagnostic, and therapeutic advances in severe sepsis and septic shock for adults, with particular relevance to emergency practice. Recommendations are provided for therapies that have been shown to improve outcomes, including early goal-directed therapy, early and appropriate antimicrobials, source control, recombinant human activated protein C, corticosteroids, and low tidal volume mechanical ventilation.
严重脓毒症和脓毒性休克与其他急诊医生经常面对的急性危及生命的疾病（如急性心肌梗死、中风和创伤）一样常见且致命。最近的研究使人们对其发病机制有了更好的理解，并推动了新的或新应用疗法的发展。这些疗法将严重脓毒症和脓毒性休克的早期积极管理视为改善预后的关键。这篇独立的文献综述探讨了成人严重脓毒症和脓毒性休克在发病机制、诊断和治疗方面的最新进展，尤其与急诊实践相关。文中针对已被证明能改善预后的疗法提供了建议，包括早期目标导向治疗、早期且恰当的抗菌药物使用、源头控制、重组人活化蛋白C、皮质类固醇以及低潮气量机械通气。
