DiPiro J T
College of Pharmacy, University of Georgia, Athens.
Am J Hosp Pharm. 1990 Nov;47(11 Suppl 3):S6-10.
The pathogenesis, clinical presentation, and complications of gram-negative bacterial sepsis are described, and the implications for therapy are reviewed. The sepsis syndrome is a clinically defined condition that involves the physiologic alterations and clinical consequences of the presence of microorganisms or their toxins in the bloodstream or tissues. Gram-negative bacteria produce sepsis and septic shock via the release of the cell-wall component known as endotoxin (lipopolysaccharide). The lipid A moiety, common to gram-negative bacteria, is immunogenic and appears to account for many of the biologic effects of endotoxin. A variety of mediators, including tumor-necrosis factor, are released in response to endotoxin, with resultant diverse effects on host tissues, including organ dysfunction and shock. Adequate treatment requires prompt recognition of infection, especially endotoxemia and sepsis, and the early institution of appropriate therapy. Corticosteroids offer little benefit, and the efficacy of naloxone and nonsteroidal anti-inflammatory drugs has not been determined. Although suitable antimicrobial therapy is necessary to eliminate the offending organisms, antimicrobial agents do not inhibit the effects of the bacterial toxins that are present in sepsis. The outcome of sepsis may be favorably influenced in the future by the use of newer methods of detection and newer treatment modalities, including monoclonal antibodies directed against endotoxin or inhibitors of inflammatory mediators.
本文描述了革兰氏阴性菌败血症的发病机制、临床表现及并发症，并对其治疗意义进行了综述。败血症综合征是一种临床定义的病症，涉及微生物或其毒素在血流或组织中存在时的生理改变及临床后果。革兰氏阴性菌通过释放称为内毒素（脂多糖）的细胞壁成分引发败血症和感染性休克。革兰氏阴性菌共有的脂质A部分具有免疫原性，似乎是内毒素许多生物学效应的原因。包括肿瘤坏死因子在内的多种介质会对内毒素产生反应而释放，从而对宿主组织产生多种影响，包括器官功能障碍和休克。充分的治疗需要迅速识别感染，尤其是内毒素血症和败血症，并尽早开始适当的治疗。皮质类固醇益处不大，纳洛酮和非甾体抗炎药的疗效尚未确定。虽然合适的抗菌治疗对于消除致病微生物是必要的，但抗菌药物并不能抑制败血症中存在的细菌毒素的作用。未来，使用更新的检测方法和更新的治疗方式，包括针对内毒素的单克隆抗体或炎症介质抑制剂，可能会对败血症的预后产生有利影响。
