AME证据系列001——转化医学协会：脓毒症诊断和早期识别的临床实践指南
| 作者: |
1,2Zhang Zhongheng,
3Smischney Nathan J.,
4Zhang Haibo,
5Poucke Sven Van,
6Tsirigotis Panagiotis,
7Rello Jordi,
8Honore Patrick M.,
9Kuan Win Sen,
1,10Ray Juliet June,
1,11Zhou Jiancang,
1,2,12Shang You,
1,3,13Yu Yuetian,
1,4,14Jung Christian,
1,5,15Robba Chiara,
1,6,16Taccone Fabio Silvio,
1,7,17Caironi Pietro,
1,8,18Grimaldi David,
1,9,19Hofer Stefan,
2,20Dimopoulos George,
1,2,21Leone Marc,
2,22Hong Sang-Bum,
2,3,23Bahloul Mabrouk,
2,4,24Argaud Laurent,
2,5,25Kim Won Young,
2,6,26Spapen Herbert D.,
2,7,27Rocco Jose Rodolfo
1 Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016 2 Department of Critical Care Medicine, Jinhua Hospital of Zhejiang University, Jinhua Zhejiang 321000 3 Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA 4 Keenan Research Center for Biomedical Science of St. Michael’s Hospital, Departments of Anesthesia and Physiology, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada 5 Departments of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium 6 2nd Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece 7 CIBERES, Vall d’Hebron Institut of Research, Universitat Autonoma de Barcelona, Spain 9 Emergency Medicine Department, National University Hospital, National University Health System, Singapore and the Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 10 DeWitt Daughtry Family Department of Surgery, Jackson Memorial Hospital, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA 11 Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016 12 Department of Critical Care Medicine, Union Hospital, Tongji Medical Collegue, Huazhong University of Science and Technology, Wuhan 430022 13 Department of Critical Care Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001 14 University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany 15 Neurosciences Critical Care Unit, Addenbrooke’s Hospital, Cambridge, UK 16 Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium 17 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy 18 Intensive Care Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium 19 Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany 20 Department of Critical Care, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece 21 Service d’anesthésie et de réanimation, Hôpital Nord, Assistance Publique – Hôpitaux de Marseille, Aix Marseille Université, Marseille, France 22 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 23 Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia 24 Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France 25 Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 26 Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels, Brussels, Belgium 27 Department of Internal Medicine and Post-graduated Program, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil |
| 通讯: |
Zhang Zhongheng
Email: zh_zhang1984@hotmail.com |
| DOI: | 10.3978/j.issn.2095-6959.2016.10.001 |
摘要
脓毒症是一种由感染引起的异质性疾病，感染触发了一系列复杂的局部或者全身的免疫炎症反应，引起多器官功能衰竭，发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准，所以脓毒症的临床诊断仍是一个难题。因此，脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而，尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险，但是这些措施的诊断价值和有效性不足以让人满意，并且没有充分的证据去建议临床使用这些新技术。因此，脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment, Development and Evaluation，GRADE)，因为大部分的研究是观察性研究，并没有对这些方法进行可靠评估，采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测，同时应该直接采用相关病人的结果数据。
关键词：
脓毒症
早期识别
诊断
AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital
DOI: 10.3978/j.issn.2095-6959.2016.10.001