Nathens A B, Marshall J C
Department of Surgery, University of Toronto, The Toronto Hospital, 200 Elizabeth Street, Toronto, Canada.
World J Surg. 1996 May;20(4):386-91. doi: 10.1007/s002689900061.
Progress in the care of the critically ill patient with life-threatening infection has been hampered by inconsistent, often confusing terminology. The clinical syndrome of sepsis-familiar to all yet definable by none-describes a highly heterogeneous group of disorders with different causes and differing prognoses. The imminent availability of mediator-directed therapy has created a sense of urgency to develop better methods for delineating discrete clinical syndromes and to modulate the host response, which may bring both benefit and harm, depending on the clinical circumstances. The term systemic inflammatory response syndrome (SIRS) was introduced several years ago to describe the familiar clinical syndrome of sepsis, independent of its cause. SIRS can result from trauma, pancreatitis, drug reactions, autoimmune disease, and a host of other disorders; when it arises in response to infection, sepsis is said to be present. SIRS describes a dynamic process that has adaptive survival value for the host. The maladaptive consequence of this process in the critically ill patient is the development of progressive but potentially reversible remote organ dysfunction-the multiple organ dysfunction syndrome. The development of cogent conceptual frameworks for classification of the septic response in critically ill patients is more than a question of linguistic pedantry. Optimal therapy presupposes identification of an homogeneous patient population with a characteristic disease process and a predictable response to an intervention. Although progress has been made in identifying such groups of critically ill patients, the disappointing results of clinical trials of agents that so clearly demonstrate efficacy in animal models indicates that considerable work remains.
危及生命的感染的重症患者护理进展一直受到不一致且常常令人困惑的术语的阻碍。脓毒症的临床综合征——大家都熟悉但却无人能确切定义——描述了一组高度异质的疾病，其病因不同，预后也不同。即将可用的介质导向疗法引发了一种紧迫感，即需要开发更好的方法来区分不同的临床综合征，并调节宿主反应，而宿主反应根据临床情况可能带来益处，也可能造成伤害。全身炎症反应综合征（SIRS）这一术语是几年前引入的，用于描述常见的脓毒症临床综合征，而不考虑其病因。SIRS可由创伤、胰腺炎、药物反应、自身免疫性疾病以及许多其他病症引起；当它因感染而出现时，就称为脓毒症。SIRS描述了一个对宿主具有适应性生存价值的动态过程。在重症患者中，这一过程的不良后果是逐渐发展但可能可逆的远隔器官功能障碍——多器官功能障碍综合征。为重症患者的脓毒症反应分类建立有说服力的概念框架，不仅仅是一个语言学上的咬文嚼字问题。最佳治疗的前提是识别出具有特征性疾病过程且对干预有可预测反应的同质患者群体。尽管在识别这类重症患者群体方面已经取得了进展，但在动物模型中已明确显示出疗效的药物在临床试验中却结果令人失望，这表明仍有大量工作要做。
