New treatment strategies for severe sepsis and septic shock
New treatment strategies for severe sepsis and septic shock
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严重脓毒症和感染性休克的新治疗策略
DOI：
10.1097/00075198-200310000-00009
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发表时间：
2003
影响因子：
3.3
通讯作者：
R. Balk
中科院分区：
文献类型：
--
作者：
G. Patel;David P. Gurka;R. Balk
综述目的严重脓毒症和脓毒性休克是危重患者发病和死亡的常见原因。脓毒症级联的复杂性继续出现，并可能为创新的患者管理确定新的目标。这篇综述将重点介绍我们在脓毒症患者治疗方面的一些最新进展。最新发现早期给予足够的抗生素治疗、有效的源头控制和有目的的血流动力学复苏是成功治疗的基石。预防危重病并发症和维持正常血糖水平也是有效管理的重要因素。在血管加压素依赖性脓毒性休克患者中，评估皮质醇反应不足，并为发现不足的患者提供生理剂量的替代类固醇可能会改善生存率。已证明给予drotalin alfa（活化）（活化蛋白C）可提高死亡风险高的严重脓毒症和脓毒性休克患者的生存率。由于其抗凝特性，在符合使用禁忌症或有出血并发症增加风险因素的患者中使用活化蛋白C时必须谨慎。总结在我们对脓毒症级联反应的理解和我们管理严重脓毒症和脓毒性休克患者的能力方面已经取得了重大进展。尽管取得了这些进展，但发病率和死亡率仍然很高。此外，对患者的财务和整体功能也有相当大的影响。
Purpose of reviewSevere sepsis and septic shock are common causes of morbidity and mortality in critically ill patients. The complexities of the septic cascade continue to emerge and may identify new targets for innovative patient management. This review will highlight some of the recent advances in our management of the patient with sepsis. Recent findingsThe early administration of adequate antibiotic therapy, effective source control, and goal-directed hemodynamic resuscitation are the cornerstone of successful management. Prevention of the complications of critical illness and maintenance of normal glucose levels are also important elements of effective management. In patients with vasopressor-dependent septic shock, evaluation for inadequate cortisol response and the provision of physiologic doses of replacement steroids for those found to be deficient may result in improved survival. Administration of drotrecogin alfa (activated), (activated protein C) has been shown to improve survival in patients with severe sepsis and septic shock who have a high risk of mortality. Because of its anticoagulant properties, caution must be exercised with the use of activated protein C in those patients who meet the contraindications for its use or who have risk factors for increased bleeding complications. SummarySignificant advances have been made in our understanding of the septic cascade and our ability to manage patients with severe sepsis and septic shock. Despite these advances, significant morbidity and mortality continue. In addition, there is also considerable impact on the financial and overall function of the patient.
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DOI：
10.1046/j.0022-202x.2001.00046.x
发表时间：
2001-12-01
影响因子：
--
作者：
Dinarello, CA
通讯作者：
Dinarello, CA
影响因子：
158.5
作者：
Brower, RG;Matthay, MA;Sibbald, WJ
通讯作者：
Sibbald, WJ
影响因子：
--
作者：
Lorenz, E;Mira, JP;Schwartz, DA
通讯作者：
Schwartz, DA
影响因子：
158.5
作者：
Martin, GS;Mannino, DM;Moss, M
通讯作者：
Moss, M