Septic Shock: Advances in Diagnosis and Treatment.
Septic Shock: Advances in Diagnosis and Treatment.
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败血性休克：诊断和治疗的进展。
DOI：
10.1001/jama.2015.7885
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发表时间：
2015-08-18
期刊：
影响因子：
--
通讯作者：
Rosengart MR
中科院分区：
文献类型：
--
作者：
Seymour CW;Rosengart MR
感染性休克是一种临床紧急情况，每年发生在超过23万美国患者中。在怀疑或记录感染的情况下，脓毒性休克通常在临床环境中被定义为低收缩压（≤90 mm Hg）或平均动脉血压（≤65 mm Hg）伴有低灌注体征（如少尿、高乳酸血症、外周灌注不良或精神状态改变）。聚焦超声检查被推荐用于及时识别复杂的生理（如低血容量或心源性休克），而侵入性血流动力学监测只推荐用于特定的患者。在感染性休克中，3个随机临床试验表明，与没有治疗方案的治疗相比，治疗方案化的治疗几乎没有优势。羟乙基淀粉不再被推荐，关于各种晶体溶液和白蛋白的作用的争论仍在继续。脓毒性休克的及时诊断始于病史和感染体征和症状的体格检查，可能需要集中超声检查来识别更复杂的休克生理表现。临床医生应了解及时给予静脉输液和血管活性药物以恢复足够血液循环的重要性，以及根据最新证据指导的基于方案的治疗的局限性。
Septic shock is a clinical emergency that occurs in more than 230 000 US patients each year. In the setting of suspected or documented infection, septic shock is typically defined in a clinical setting by low systolic (≤90 mm Hg) or mean arterial blood pressure (≤65 mm Hg) accompanied by signs of hypoperfusion (eg, oliguria, hyperlactemia, poor peripheral perfusion, or altered mental status). Focused ultrasonography is recommended for the prompt recognition of complicating physiology (eg, hypovolemia or cardiogenic shock), while invasive hemodynamic monitoring is recommended only for select patients. In septic shock, 3 randomized clinical trials demonstrate that protocolized care offers little advantage compared with management without a protocol. Hydroxyethyl starch is no longer recommended, and debate continues about the role of various crystalloid solutions and albumin. The prompt diagnosis of septic shock begins with obtainment of medical history and performance of a physical examination for signs and symptoms of infection and may require focused ultrasonography to recognize more complex physiologic manifestations of shock. Clinicians should understand the importance of prompt administration of intravenous fluids and vasoactive medications aimed at restoring adequate circulation, and the limitations of protocol-based therapy, as guided by recent evidence.