Sepsis definitions: time for change.
Sepsis definitions: time for change.
复制标题
DOI：
10.1016/s0140-6736(12)61815-7
复制
发表时间：
2013-03-02
期刊：
影响因子：
--
通讯作者：
Tracey KJ
中科院分区：
文献类型：
--
作者：
Vincent JL;Opal SM;Marshall JC;Tracey KJ
脓毒症的现代概念集中在人类对入侵生物的反应。1991年，北美共识会议提出了脓毒症是宿主对感染的炎症反应的观点。1为简单起见，全身炎症反应综合征（SIRS）由四个变量定义：体温、心率、呼吸频率和白色血细胞计数。只有轻微的异常，这些变量是需要一个病人，以满足SIRS标准。这些简单的临床标准使研究人员能够确定患者参加败血症试验，并迅速被采用。然而，SIRS方法有三个主要问题。首先，SIRS标准非常敏感，以至于高达90%的重症监护室（ICU）患者符合标准。2，3 SIRS可由许多非感染性临床过程引起，如严重创伤、烧伤、胰腺炎和缺血再灌注事件。如果脓毒症是由SIRS标准加上感染的存在定义的，并且几乎每个急性病患者都符合SIRS标准，那么脓毒症实际上等于感染。但是，尽管所有的脓毒症患者都有感染，但反过来并不一定是正确的，即不是所有的感染患者都有脓毒症。其次，某种程度的宿主反应实际上是感染所固有的;事实上，这是感染与单纯的定植之间差异的重要组成部分。几乎所有的感染，即使是轻微的病毒性疾病，通常都阿索发热和伴随的变化，包括心动过速、某些换气过度和白色细胞计数增加。这种宿主反应具有有益的方面，并且反应减少或不存在可能表明个体是免疫受损的。第三，解读
The modern concept of sepsis has focused on the human response to invading organisms. In 1991, a North American consensus conference introduced the idea that sepsis is the host’s inflammatory response to in fection. 1 For simplicity, the systemic inflammatory re sponse syndrome (SIRS) was defined by four variables: temperature, heart rate, respiratory rate, and white blood cell count. Only minor abnormalities in these variables are needed for a patient to meet the SIRS criteria. These simple clinical criteria allowed researchers to identify patients to enrol in sepsis trials and were rapidly adopted. However, the SIRS approach has three major problems. First, the SIRS criteria are so sensitive that up to 90% of patients admitted to an intensive care unit (ICU) meet the criteria. 2, 3SIRS can be caused by many non-infectious clinical processes, such as severe trauma, burns, pancreatitis, and ischaemic reperfusion events. If sepsis is defined by the presence of SIRS criteria plus an infection, and almost every acutely ill patient meets the SIRS criteria, then sepsis effectively equals infection. But, although all patients with sepsis have an infection, the reverse is not necessarily true—ie, not all patients with an infection have sepsis. Second, some degree of host response is actually inherent to the infection; indeed, this is an important component of the difference between infection and mere colonisation. Almost any infection—even a minor viral illness—is typically asso ciated with fever and accompanying changes, including tachycardia, some hyperventilation, and an increased white cell count. This host response has beneficial aspects, and a reduced or absent reaction could suggest that the individual is immunocompromised. Third, deciphering the role of