Martín Silvia, Pérez Alba, Aldecoa Cesar
Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega , Valladolid , Spain.
Anaesthesia and Surgical Critical Care, Hospital Universitario rio Hortega, Valladolid, Spain; University of Valladolid Medical School, Valladolid, Spain.
Front Med (Lausanne). 2017 Feb 28;4:20. doi: 10.3389/fmed.2017.00020. eCollection 2017.
Sepsis is a prevalent, serious medical condition with substantial mortality and a significant consumption of health-care resources. Its incidence has increased around 9% annually in general population over the last years and specially in aged patients group. Several risk factors such as comorbidities, preadmission status, malnutrition, frailty, and an impared function in the immune system called immunosenescence are involved in the higher predisposition to sepsis in the elderly patients. Immunosenescence status consists in a functional impairment in both cell-mediated immunity and humoral immune responses and increases not only the risk for develop sepsis but also lead to more severe presentation of infection and may be is also related with a higher mortality. There is a also a concern about to admit patients in the intensive care units taking into account that the outcome of elderly patients is poorer compared to younger people. Nevertheless, the management of septic elderly patients does not differ substantially from younger people. In addition, the quality of life in septic elderly survivors is also lower than in younger people. But age, as alone factor, should not be used to determine treatment options because the poorer outcomes is thought to be due to the increased comorbidities and frailty in this group of patients.
脓毒症是一种常见且严重的疾病，死亡率高，消耗大量医疗资源。在过去几年中，普通人群中其发病率每年约增加9%，老年患者群体中尤为如此。多种风险因素，如合并症、入院前状态、营养不良、虚弱以及免疫系统功能受损（称为免疫衰老），使得老年患者更易患脓毒症。免疫衰老表现为细胞介导免疫和体液免疫反应的功能障碍，不仅增加了发生脓毒症的风险，还导致感染表现更为严重，可能还与更高的死亡率相关。考虑到老年患者在重症监护病房的预后比年轻人差，是否收治老年患者也令人担忧。然而，脓毒症老年患者的治疗与年轻人并无显著差异。此外，脓毒症老年幸存者的生活质量也低于年轻人。但年龄本身不应作为决定治疗方案的因素，因为该群体较差的预后被认为是由于合并症增加和身体虚弱所致。
