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重新思考脓毒症和脓毒性休克的概念。

Rethinking the concept of sepsis and septic shock.

机构信息

Hospital de Santa Maria/CHLN, Portugal.

Hospital de Santa Maria/CHLN, Portugal; Faculdade de Medicina de Lisboa, Portugal.

出版信息

Eur J Intern Med. 2018 Aug;54:1-5. doi: 10.1016/j.ejim.2018.06.002. Epub 2018 Jun 18.

Abstract

Sepsis is a major global health problem and represents a challenge for physicians all over the world. The knowledge of sepsis and septic shock is a topic of interest among the scientific community and society in general. New guidelines for management of sepsis and septic shock were developed in 2016, providing an update on this area. In Sepsis-3 new definitions for sepsis and septic shock were published. The purpose of this narrative review is to discuss and compare the new criteria of 2016 with the old criteria, purposing at the same time an alternative approach for this topic. SOFA criteria (Sequential Organ Failure Assessment Score) are more complete, but too extensive and usually difficult to apply outside the intensive care units, therefore inducing potentially delay in the proper treatment. We purpose combined criteria for the selection of sepsis patients. Initially, we could apply qSOFA (quick Sepsis Related Organ Failure Assessment) criteria, due to its easy application, associated with the SIRS (systemic inflammatory response syndrome) criteria, allowing to select the patients who are infected and need faster treatment. In that way we would use the best of old and newest criteria, allowing the early selection of patients who are infected and require faster treatment, while the search for a better and faster tool continues.

摘要

脓毒症是一个全球性的主要健康问题,也是全世界医生面临的挑战。脓毒症和感染性休克的知识是科学界和整个社会关注的话题。2016 年制定了新的脓毒症和感染性休克管理指南,为该领域提供了最新的更新。在 Sepsis-3 中,公布了脓毒症和感染性休克的新定义。本叙述性综述的目的是讨论和比较 2016 年的新标准与旧标准,并同时为这一主题提出一种替代方法。SOFA 标准(序贯器官衰竭评估评分)更全面,但过于广泛,通常难以在重症监护病房外应用,因此可能会延迟适当的治疗。我们提出了用于选择脓毒症患者的联合标准。最初,我们可以应用 qSOFA(快速脓毒症相关器官衰竭评估)标准,因为它易于应用,与 SIRS(全身炎症反应综合征)标准相关,允许选择感染且需要更快治疗的患者。这样,我们将利用新旧标准的优点,允许早期选择感染且需要更快治疗的患者,同时继续寻找更好、更快的工具。

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