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[脓毒症治疗中的循证医学是什么?]

[What is evidence-based in the treatment of sepsis?].

作者信息

Stahl K, Seeliger B, David S, Schmidt J

机构信息

Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.

Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland.

出版信息

Internist (Berl). 2020 Dec;61(12):1238-1248. doi: 10.1007/s00108-020-00895-w.

Abstract

BACKGROUND

The term sepsis was redefined in 2016 as a life-threatening organ dysfunction caused by an inadequate host response to an infection. The German S3 guidelines for the treatment of sepsis were published in 2018.

OBJECTIVE

What is evidence-based in the treatment of patients with sepsis?

MATERIAL AND METHODS

Discussion of the S3 guidelines and inclusion of study results after 2018.

RESULTS

The cornerstones for the treatment of sepsis continue to consist of early hemodynamic stabilization, anti-infection treatment and organ support procedures. Supportive and extracorporeal treatments are controversially discussed and continue to be intensively investigated.

CONCLUSION

Despite an improved understanding of the pathophysiology, there is still no effective causal sepsis treatment, i.e. directed against the pathological host reaction. The treatment of patients with sepsis is therefore still based on the basic principles of correction of volume deficits, anti-infective agents, source control and organ support, including the symptomatic treatment of vasoplegia with catecholamines.

摘要

背景

2016年,脓毒症被重新定义为宿主对感染反应不足所导致的危及生命的器官功能障碍。德国脓毒症治疗S3指南于2018年发布。

目的

脓毒症患者治疗中的循证医学依据是什么?

材料与方法

对S3指南进行讨论,并纳入2018年后的研究结果。

结果

脓毒症治疗的基石仍然包括早期血流动力学稳定、抗感染治疗和器官支持程序。支持性治疗和体外治疗存在争议,仍在深入研究中。

结论

尽管对病理生理学的理解有所改善,但仍然没有有效的脓毒症病因治疗方法,即针对病理性宿主反应的治疗方法。因此,脓毒症患者的治疗仍然基于纠正容量不足、抗感染药物、源头控制和器官支持的基本原则,包括用儿茶酚胺对血管麻痹进行对症治疗。

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