Marik Paul E, Lipman Jeffrey
Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
Crit Care Resusc. 2007 Mar;9(1):101-3.
Sepsis is among the most common reasons for admission to intensive care units throughout the world. In 1991, a new set of terms and definitions was developed to define sepsis more precisely. The concept of the "systemic inflammatory response syndrome" (SIRS) was developed, and its diagnostic criteria were defined. Sepsis was defined as suspected or microbiologically proven infection together with SIRS, while severe sepsis was defined as sepsis together with sepsis-induced organ dysfunction. Septic shock was defined as sepsis-induced hypotension persisting despite adequate fluid resuscitation. Data from recently published trials support this hierarchical stratification, with the mortality from sepsis ranging from 10% to 15%, severe sepsis from 17% to 20%, and septic shock from 43% to 54%. The distinction between severe sepsis and septic shock is critically important as it stratifies patients into groups with a low and a high risk of dying, respectively. However, currently the diagnostic criteria of septic shock remain vague. We suggest that septic shock is best defined by a systolic blood pressure less than 90 mmHg (or a fall in systolic blood pressure of > 40 mmHg), or a mean arterial pressure less than 65 mmHg after a crystalloid fluid challenge of 30 mL per kg body weight in a patient with severe sepsis. We believe that a vasopressor should be initiated in patients who remain hypotensive after this fluid challenge. The above operational definition of septic shock is important, as it clearly and unambiguously defines in which patients, and when, treatment with a vasopressor should be initiated, and in which patients adjunctive therapy with hydrocortisone and drotrecogin alfa (activated) should be considered.
脓毒症是全球重症监护病房收治患者的最常见原因之一。1991年，人们制定了一套新的术语和定义，以便更精确地界定脓毒症。“全身炎症反应综合征”（SIRS）的概念由此提出，并明确了其诊断标准。脓毒症被定义为疑似或经微生物学证实的感染合并SIRS，而严重脓毒症则被定义为脓毒症合并脓毒症诱导的器官功能障碍。感染性休克被定义为尽管进行了充分的液体复苏，但仍持续存在的脓毒症诱导的低血压。近期发表的试验数据支持这种分层分类，脓毒症的死亡率为10%至15%，严重脓毒症为17%至20%，感染性休克为43%至54%。区分严重脓毒症和感染性休克至关重要，因为这分别将患者分为死亡风险低和高的两组。然而，目前感染性休克的诊断标准仍不明确。我们建议，对于严重脓毒症患者，在给予每千克体重30 mL晶体液冲击后，若收缩压低于90 mmHg（或收缩压下降>40 mmHg），或平均动脉压低于65 mmHg，则最适合定义为感染性休克。我们认为，对于在液体冲击后仍处于低血压状态的患者，应开始使用血管升压药。上述感染性休克的操作定义很重要，因为它清晰明确地界定了哪些患者以及何时应开始使用血管升压药治疗，以及哪些患者应考虑使用氢化可的松和活化蛋白C进行辅助治疗。
