Škrtić A
Acta Med Croatica. 2015 Sep;69(3):217-20.
Severe sepsis and septic shock are the major healthcare problem with high mortality and increasing incidence. Most cases of septic shock are caused by gram-negative bacilli or gram-positive cocci. In diagnostic algorithm, microbial culture and molecular analysis of tissue and body liquid should be obtained in patients with documented history of infection. Morphological analysis of tissue should be performed for diagnostic purpose in cases where the results of diagnostic tests are negative or when the patient clinically deteriorates despite standard therapeutic management of severe sepsis and septic shock. Morphological changes that can be found in a patient with sepsis include reversible and irreversible cell injury, cell necrosis, inflammatory and other pathological changes that can cause functional organ failure. Analysis of infectious agents can be performed using special methods, histochemical, immunohistochemical and immunofluorescence staining. Morphological analysis of pathological processes can be performed in cases of patient death. Autopsy is one of the most reliable methods to validate clinical diagnosis. In a patient with severe sepsis and septic shock, morphological analysis of tissue and organs, which can be performed during diagnostic algorithm, as well as on autopsy, presents diagnostic and final validation of clinical diagnosis and contributes to appropriate patient care, therapy and improved health quality.
严重脓毒症和脓毒性休克是主要的医疗保健问题，死亡率高且发病率不断上升。大多数脓毒性休克病例由革兰氏阴性杆菌或革兰氏阳性球菌引起。在诊断流程中，对于有明确感染史的患者，应进行组织和体液的微生物培养及分子分析。当诊断测试结果为阴性或患者尽管接受了严重脓毒症和脓毒性休克的标准治疗但临床仍恶化时，应为诊断目的进行组织形态学分析。脓毒症患者可出现的形态学变化包括可逆和不可逆的细胞损伤、细胞坏死、炎症及其他可导致器官功能衰竭的病理变化。可使用特殊方法、组织化学、免疫组织化学和免疫荧光染色进行感染病原体分析。病理过程的形态学分析可在患者死亡时进行。尸检是验证临床诊断最可靠的方法之一。在严重脓毒症和脓毒性休克患者中，可在诊断流程中以及尸检时进行的组织和器官形态学分析，为临床诊断提供诊断和最终验证，并有助于对患者进行适当的护理、治疗及提高健康质量。
