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脓毒症筛查:全身炎症反应综合征(SIRS)还是快速序贯器官衰竭评估(qSOFA)?文献综述

Screening for sepsis: SIRS or qSOFA? A literature review.

作者信息

Feist Benjamin

机构信息

Emergency department, London North West University Healthcare NHS Trust, London, England.

出版信息

Emerg Nurse. 2019 Nov 5;27(6):13-18. doi: 10.7748/en.2019.e1939. Epub 2019 Sep 28.

Abstract

In 2016, definitions of sepsis and septic shock were updated to focus on organ dysfunction rather than systemic inflammatory response as the identifying trait. This article aims to compare and evaluate the effectiveness of systemic inflammatory response syndrome (SIRS) and quick Sequential Organ Failure Assessment (qSOFA) in detecting sepsis in emergency department (ED) patients. A systematic search of the literature was undertaken using four databases. A total of 307 articles was identified. After the selection process, 13 articles met the inclusion criteria for the review. Five themes emerged from the meta-analysis: SIRS; qSOFA; timeliness and simplicity; sensitivity versus specificity; and adding lacate. SIRS offered users greater sensitivity when assessing for sepsis. However, qSOFA is a simple bedside tool with greater specificity, which does not require any blood test results. The author created a new qSOFA screening tool, which incorporated the use of point-of-care serum lactate measurement. He found that qSOFA outperforms SIRS as an ED sepsis screening tool with its strengths of efficacy, efficiency and ease. It was also found to differentiate better between uncomplicated infection and sepsis, which can commonly cause trigger fatigue in EDs.

摘要

2016年,脓毒症和脓毒性休克的定义进行了更新,重点关注器官功能障碍而非全身炎症反应这一识别特征。本文旨在比较和评估全身炎症反应综合征(SIRS)和快速序贯器官衰竭评估(qSOFA)在急诊科(ED)患者中检测脓毒症的有效性。使用四个数据库对文献进行了系统检索。共识别出307篇文章。经过筛选过程,13篇文章符合综述的纳入标准。荟萃分析得出了五个主题:SIRS;qSOFA;及时性和简易性;敏感性与特异性;以及添加乳酸盐。在评估脓毒症时,SIRS为使用者提供了更高的敏感性。然而,qSOFA是一种简单的床边工具,具有更高的特异性,且不需要任何血液检测结果。作者创建了一种新的qSOFA筛查工具,该工具纳入了即时检验血清乳酸盐测量的应用。他发现,作为急诊科脓毒症筛查工具,qSOFA在有效性、效率和易用性方面优于SIRS。研究还发现,它能更好地区分单纯性感染和脓毒症,而这两种情况在急诊科通常会导致触发疲劳。

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