Rackow E C, Astiz M E
Department of Medicine, St. Vincent's Hospital and Medical Center, New York, NY 10011.
JAMA. 1991;266(4):548-54.
The mortality from septic shock continues to range between 40% to 60% despite advances in cardiovascular support and antibiotic therapy. Impairment of host defenses predisposes to the development of both severe infection and septic shock. The activation of a myriad of cellular and plasma mediators by microbial toxins produces the systemic and metabolic manifestations of sepsis. The clinical presentation includes characteristic clinical, hemodynamic, and laboratory abnormalities. Multiple organ systems are involved during septic shock, with outcome dependent on the circulatory response and the development of sequential organ failures. Initial resuscitation is directed at restoring tissue perfusion with fluids and vasoactive drugs, guided by assessment of the patient's hemodynamic status. Identification of the site of infection and choice of appropriate antibiotics are critical to the success of therapy. Newer therapeutic modalities include immunologic interventions that attenuate mediator activity and modulate the immune response. Pharmacologic therapies are also being developed that are aimed at blocking the actions of specific mediators.
尽管在心血管支持和抗生素治疗方面取得了进展，但感染性休克的死亡率仍在40%至60%之间。宿主防御功能受损易导致严重感染和感染性休克的发生。微生物毒素激活大量细胞和血浆介质，产生脓毒症的全身和代谢表现。临床表现包括典型的临床、血流动力学和实验室异常。感染性休克期间多个器官系统受累，结局取决于循环反应和序贯器官衰竭的发生。初始复苏旨在通过液体和血管活性药物恢复组织灌注，以患者血流动力学状态评估为指导。确定感染部位和选择合适的抗生素对治疗成功至关重要。新的治疗方式包括免疫干预，可减弱介质活性并调节免疫反应。也正在研发旨在阻断特定介质作用的药物疗法。
