Department of Critical Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
Langenbecks Arch Surg. 2010 Jun;395(5):489-94. doi: 10.1007/s00423-010-0650-1. Epub 2010 Jun 2.
Early appropriate therapy in terms of early fluid resuscitation and early antibiotic therapy is beneficial in patients with severe sepsis and septic shock. The purpose of this review is to address the role of early source control in the management of patients with severe sepsis.
Establishing a clinical diagnosis as soon as possible is a prerequisite in patients with severe sepsis; in some cases, a surgical procedure can also serve as a diagnostic tool. Although source control is considered an essential element in the management of these patients, the definition and usefulness of early source control is not clear. Often, it is suggested that in non-severely ill patients, source control can be postponed up to 24 h, but this is related more to the lack of studies that demonstrate an advantage of early source control than to a sound pathophysiological rationale. Obstacles to early source control are numerous, but in most patients, there is little reason to delay source control for more than a few hours to allow preoperative optimization and correction of metabolic derangements. Finally, a three-level classification of urgency for source control measures is proposed. For every patient, the most appropriate method suited at that particular moment has to be chosen.
Source control is considered an essential element in the management of sepsis and should be considered and performed early after the diagnosis is established in most if not all patients.
在严重脓毒症和感染性休克患者中，早期进行适当的液体复苏和抗生素治疗是有益的。本综述的目的是探讨早期源头控制在严重脓毒症患者管理中的作用。
尽快建立临床诊断是严重脓毒症患者的前提条件；在某些情况下，手术过程也可以作为一种诊断工具。尽管源头控制被认为是这些患者治疗的重要组成部分，但早期源头控制的定义和作用尚不清楚。通常，人们认为在非重病患者中，可以将源头控制推迟至 24 小时，但这更多地与缺乏证明早期源头控制优势的研究有关，而不是基于合理的病理生理学原理。早期源头控制存在许多障碍，但在大多数患者中，没有理由将源头控制推迟几个小时以上，以允许进行术前优化和纠正代谢紊乱。最后，提出了一种三级分类的源头控制措施的紧急程度。对于每个患者，都必须选择在该特定时刻最合适的方法。
源头控制被认为是脓毒症治疗的重要组成部分，应在大多数（如果不是全部）患者确诊后尽早考虑和实施。
