Hecker A, Uhle F, Schwandner T, Padberg W, Weigand M A
Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany,
Langenbecks Arch Surg. 2014 Jan;399(1):11-22. doi: 10.1007/s00423-013-1132-z. Epub 2013 Nov 2.
In the perioperative phase, sepsis and sepsis-associated death are the most important problems for both the surgeon and the intensivist. Critically ill patients profit from an early identification and implementation of an interdisciplinary therapy. The purpose of this review on septic peritonitis is to give an update on the diagnosis and its evidence-based treatment.
Rapid diagnosis of sepsis is essential for patient´s survival. A bundle of studies was performed on early recognition and on new diagnostic tools for abdominal sepsis. Although surgical intervention is considered as an essential therapeutic step in sepsis therapy the time-point of source control is still controversially discussed in the literature. Furthermore, the Surviving Sepsis Campaign (SSC) guidelines were updated in 2012 to facilitate evidence-based medicine for septic patients.
Despite many efforts, the mortality of surgical septic patients remains unacceptably high. Permanent clinical education and further surgical trials are necessary to improve the outcome of critically ill patients.
在围手术期,脓毒症及脓毒症相关死亡对外科医生和重症监护医生而言都是最重要的问题。危重症患者可从早期识别并实施多学科治疗中获益。本关于感染性腹膜炎综述的目的是对其诊断及循证治疗进行更新。
脓毒症的快速诊断对患者存活至关重要。针对腹部脓毒症的早期识别及新诊断工具开展了一系列研究。尽管手术干预被视为脓毒症治疗的关键治疗步骤,但文献中对源头控制的时间点仍存在争议。此外,《拯救脓毒症运动(SSC)指南》于2012年进行了更新,以促进脓毒症患者的循证医学。
尽管付出诸多努力,外科脓毒症患者的死亡率仍高得令人难以接受。持续的临床教育及进一步的外科试验对于改善危重症患者的治疗结局很有必要。