Crowley K, Phelan D
Department of Anaesthesia and Intensive Care, Mater Hospital, Dublin.
Ir Med J. 1990 Sep;83(3):121-4.
Septicaemia frequently presents without "classic" signs of infection--tachypnoea, hypotension and confusion are the commonest features. The mortality rate is 40 to 80% and in intensive care units, septicaemia accounts for 70% of all deaths. Despite the use of antimicrobial drugs to which the offending organism is sensitive, patients are still dying. Effects on distant organ systems are due to "Mediators". "Microvascular Failure" resulting in tissue hypoxia is the unifying hypothesis of multiple organ failure in septicaemia. Mortality is correlated with the number of organ system failures. Supportive management is aimed at prevention of organ failure--manipulation of the circulation being the central key. Intravascular volume expansion, vasoactive drugs, mechanical ventilation and invasive monitoring are the means. Antimicrobial therapy must be guided by 'best guess' approach with multiple agents until isolation of the offending organism can recommend specific therapy. Aggressive surgical drainage or excision, is particularly applicable in abdominal sepsis. Several adjunctive therapies aimed at mediators of sepsis, are as yet experimental.
败血症常常没有“典型”的感染迹象——呼吸急促、低血压和意识模糊是最常见的特征。死亡率为40%至80%，在重症监护病房，败血症占所有死亡病例的70%。尽管使用了致病微生物敏感的抗菌药物，但患者仍在死亡。对远处器官系统的影响是由“介质”引起的。导致组织缺氧的“微血管功能衰竭”是败血症多器官功能衰竭的统一假说。死亡率与器官系统衰竭的数量相关。支持性治疗旨在预防器官衰竭——循环系统的调控是关键核心。血管内容量扩充、血管活性药物、机械通气和侵入性监测是治疗手段。在致病微生物分离出来能够推荐特定治疗方法之前，抗菌治疗必须采用多种药物的“最佳猜测”方法。积极的手术引流或切除，尤其适用于腹部脓毒症。几种针对败血症介质的辅助治疗方法仍处于实验阶段。
