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儿童脓毒症:最新治疗方法

Sepsis in children: state-of-the-art treatment.

作者信息

Peshimam Niha, Nadel Simon

机构信息

Paediatric Intensive Care, St Mary's Hospital, London, UK.

Consultant and Adjunct Professor, Paediatric Intensive Care, St Mary's Hospital and Imperial College London, London, W2 1NY, UK.

出版信息

Ther Adv Infect Dis. 2021 Nov 23;8:20499361211055332. doi: 10.1177/20499361211055332. eCollection 2021 Jan-Dec.

DOI:10.1177/20499361211055332
PMID:34868580
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8637770/
Abstract

Sepsis is a common, complex condition that requires early recognition and aggressive management to improve outcomes. There has been significant improvement in the management of sepsis and septic shock in the last decade; however, it continues to be a leading cause of mortality, morbidity and burden on healthcare services globally. Several guidelines with evidence-based recommendations for the management of children with septic shock and associated organ dysfunction have been produced with the objective of helping clinicians in various settings to provide standardised high-quality care. This article aims to increase awareness among all clinicians, including those working in emergency departments, general paediatric wards and primary care physicians, about the management of sepsis in children.

摘要

脓毒症是一种常见且复杂的病症,需要早期识别和积极治疗以改善预后。在过去十年中,脓毒症和脓毒性休克的治疗有了显著改善;然而,它仍然是全球范围内导致死亡、发病以及给医疗服务带来负担的主要原因。已经制定了多项针对脓毒性休克患儿及相关器官功能障碍管理的循证指南,目的是帮助不同环境下的临床医生提供标准化的高质量护理。本文旨在提高所有临床医生的认识,包括急诊科医生、普通儿科病房医生和基层医疗医生,使其了解儿童脓毒症的治疗方法。

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1
Sepsis in children: state-of-the-art treatment.儿童脓毒症:最新治疗方法
Ther Adv Infect Dis. 2021 Nov 23;8:20499361211055332. doi: 10.1177/20499361211055332. eCollection 2021 Jan-Dec.
2
Sepsis Care Pathway 2019.2019年脓毒症护理路径
Qatar Med J. 2019 Nov 7;2019(2):4. doi: 10.5339/qmj.2019.qccc.4. eCollection 2019.
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Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.拯救脓毒症运动:严重脓毒症和脓毒性休克管理国际指南:2012 年。
Crit Care Med. 2013 Feb;41(2):580-637. doi: 10.1097/CCM.0b013e31827e83af.
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Treatment of Pediatric Septic Shock With the Surviving Sepsis Campaign Guidelines and PICU Patient Outcomes.采用脓毒症存活策略指南治疗小儿脓毒性休克及儿科重症监护病房患者的预后
Pediatr Crit Care Med. 2016 Oct;17(10):e451-e458. doi: 10.1097/PCC.0000000000000906.
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Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.拯救脓毒症运动:严重脓毒症和脓毒性休克治疗国际指南:2008年版
Crit Care Med. 2008 Jan;36(1):296-327. doi: 10.1097/01.CCM.0000298158.12101.41.
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Sepsis and septic shock: current approaches to management.脓毒症和感染性休克:当前的治疗方法。
Intern Med J. 2019 Feb;49(2):160-170. doi: 10.1111/imj.14199.
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Sepsis and septic shock.脓毒症和脓毒性休克。
Lancet. 2018 Jul 7;392(10141):75-87. doi: 10.1016/S0140-6736(18)30696-2. Epub 2018 Jun 21.
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Delayed Administration of Antibiotics Beyond the First Hour of Recognition Is Associated with Increased Mortality Rates in Children with Sepsis/Severe Sepsis and Septic Shock.延迟给予抗生素超过发病后 1 小时与脓毒症/严重脓毒症和感染性休克患儿的死亡率增加相关。
J Pediatr. 2021 Jun;233:183-190.e3. doi: 10.1016/j.jpeds.2020.12.035. Epub 2021 Jan 26.
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Early identification and management of patients with severe sepsis and septic shock in the emergency department.急诊科对严重脓毒症和脓毒性休克患者的早期识别与处理
Emerg Med Clin North Am. 2014 Nov;32(4):759-76. doi: 10.1016/j.emc.2014.07.002. Epub 2014 Sep 3.
10
Infection Management in Patients with Sepsis and Septic Shock in Resource-Limited Settings资源有限环境下脓毒症和脓毒性休克患者的感染管理

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Med J Armed Forces India. 2025 May-Jun;81(3):282-290. doi: 10.1016/j.mjafi.2023.09.011. Epub 2023 Nov 3.
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Clinical efficacy of IgM-enriched immunoglobulin as adjunctive therapy in neonatal and pediatric sepsis: a systematic review and meta-analysis.富含IgM的免疫球蛋白作为新生儿和儿童脓毒症辅助治疗的临床疗效:一项系统评价和荟萃分析
Front Pediatr. 2023 Aug 11;11:1239014. doi: 10.3389/fped.2023.1239014. eCollection 2023.
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Automated digital technologies for supporting sepsis prediction in children: a scoping review protocol.用于支持儿童脓毒症预测的自动化数字技术:范围综述方案。
BMJ Open. 2022 Nov 22;12(11):e065429. doi: 10.1136/bmjopen-2022-065429.

本文引用的文献

1
Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2.58 例与 SARS-CoV-2 相关的儿童炎症性多系统综合征的临床特征。
JAMA. 2020 Jul 21;324(3):259-269. doi: 10.1001/jama.2020.10369.
2
Utility of Procalcitonin as a Biomarker for Sepsis in Children.降钙素原作为儿童脓毒症生物标志物的效用
J Clin Microbiol. 2020 Jun 24;58(7). doi: 10.1128/JCM.01851-19.
3
Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children.《拯救脓毒症运动:儿童脓毒性休克及脓毒症相关器官功能障碍管理国际指南》
Pediatr Crit Care Med. 2020 Feb;21(2):e52-e106. doi: 10.1097/PCC.0000000000002198.
4
Reducing Collateral Damage From Mandates for Time to Antibiotics in Pediatric Sepsis-Primum Non Nocere.减少儿科脓毒症中抗生素使用时间规定带来的附带损害——首要原则是不伤害。
JAMA Pediatr. 2019 May 1;173(5):409-410. doi: 10.1001/jamapediatrics.2019.0174.
5
Therapeutic Plasma Exchange in Children With Thrombocytopenia-Associated Multiple Organ Failure: The Thrombocytopenia-Associated Multiple Organ Failure Network Prospective Experience.血小板减少相关多器官衰竭患儿的治疗性血浆置换:血小板减少相关多器官衰竭网络前瞻性经验。
Crit Care Med. 2019 Mar;47(3):e173-e181. doi: 10.1097/CCM.0000000000003559.
6
Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study.儿科急性呼吸窘迫综合征的发病率和流行病学(PARDIE):一项国际性、观察性研究。
Lancet Respir Med. 2019 Feb;7(2):115-128. doi: 10.1016/S2213-2600(18)30344-8. Epub 2018 Oct 22.
7
Recommendations on RBC Transfusions for Critically Ill Children With Nonhemorrhagic Shock From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative.儿科危重病输血和贫血专业知识倡议:关于非出血性休克危重症儿童红细胞输注的建议。
Pediatr Crit Care Med. 2018 Sep;19(9S Suppl 1):S121-S126. doi: 10.1097/PCC.0000000000001620.
8
Restricted fluid bolus volume in early septic shock: results of the Fluids in Shock pilot trial.早期感染性休克患者限制液体冲击量:休克试验的初步结果。
Arch Dis Child. 2019 May;104(5):426-431. doi: 10.1136/archdischild-2018-314924. Epub 2018 Aug 7.
9
Pediatric Antimicrobial Stewardship: State of the Art.儿科抗菌药物管理:最新进展
Curr Infect Dis Rep. 2018 Aug 1;20(10):39. doi: 10.1007/s11908-018-0644-7.
10
Venoarterial Extracorporeal Membrane Oxygenation Versus Conventional Therapy in Severe Pediatric Septic Shock.脉动脉体外膜肺氧合与常规疗法治疗小儿严重脓毒性休克的比较。
Pediatr Crit Care Med. 2018 Oct;19(10):965-972. doi: 10.1097/PCC.0000000000001660.