Ratanarat Ranistha, Permpikul Chairat
Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2007 May;90(5):1021-31.
Severe sepsis represents the leading cause of mortality and morbidity in critically ill patients. Although the authors' understanding of the complex pathophysiological alterations that occur in severe sepsis and septic shock has increased greatly, mortality associated with the disorder remains unacceptably high. Recent treatment guidelines have reinforced the importance of early goal directed therapy. Recently, moderate doses of corticosteroid replacement and activated protein C (drotrecogin alfa[activated]) are the therapies demonstrating efficacy. Extra-corporeal blood purification techniques offer a variety of techniques that can efficiently eliminate septic mediators. The rationale for its use in sepsis is sound Animal and human studies show promise with improvements in hemodynamics and mortality, but are limited by number and design. These techniques require large-scale well-conducted studies to demonstrate the validity in sepsis.
严重脓毒症是重症患者死亡和发病的主要原因。尽管作者对严重脓毒症和脓毒性休克中发生的复杂病理生理改变的理解有了很大提高，但与该疾病相关的死亡率仍然高得令人无法接受。最近的治疗指南强化了早期目标导向治疗的重要性。近来，中等剂量的皮质类固醇替代治疗和活化蛋白C（重组人活化蛋白C）是显示出疗效的治疗方法。体外血液净化技术提供了多种可有效清除脓毒症介质的技术。其用于脓毒症的理论依据合理。动物和人体研究显示在改善血流动力学和死亡率方面有前景，但受数量和设计所限。这些技术需要大规模的高质量研究来证明其在脓毒症中的有效性。
