Armstrong Bracken A, Betzold Richard D, May Addison K
Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Ave S Medical Arts Building 404, Nashville, TN 37212, USA.
Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, 1211 21st Ave S Medical Arts Building 404, Nashville, TN 37212, USA.
Surg Clin North Am. 2017 Dec;97(6):1339-1379. doi: 10.1016/j.suc.2017.07.003. Epub 2017 Oct 5.
Three therapeutic principles most substantially improve organ dysfunction and survival in sepsis: early, appropriate antimicrobial therapy; restoration of adequate cellular perfusion; timely source control. The new definitions of sepsis and septic shock reflect the inadequate sensitivity, specify, and lack of prognostication of systemic inflammatory response syndrome criteria. Sequential (sepsis-related) organ failure assessment more effectively prognosticates in sepsis and critical illness. Inadequate cellular perfusion accelerates injury and reestablishing perfusion limits injury. Multiple organ systems are affected by sepsis and septic shock and an evidence-based multipronged approach to systems-based therapy in critical illness results in improve outcomes.
早期、恰当的抗菌治疗；恢复充足的细胞灌注；及时控制感染源。脓毒症和脓毒性休克的新定义反映出全身炎症反应综合征标准的敏感性不足、特异性差且缺乏预后价值。序贯（与脓毒症相关的）器官衰竭评估能更有效地对脓毒症和危重病进行预后判断。细胞灌注不足会加速损伤，而恢复灌注则可限制损伤。脓毒症和脓毒性休克会影响多个器官系统，基于循证的多管齐下的危重病系统治疗方法可改善治疗结果。
