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Sepsis并非感染:支持“拯救Sepsis运动”

隆云 刘大为

隆云, 刘大为. Sepsis并非感染:支持“拯救Sepsis运动”[J]. 协和医学杂志, 2018, 9(5): 411-416. doi: 10.3969/j.issn.1674-9081.2018.05.007
引用本文: 隆云, 刘大为. Sepsis并非感染:支持“拯救Sepsis运动”[J]. 协和医学杂志, 2018, 9(5): 411-416. doi: 10.3969/j.issn.1674-9081.2018.05.007
Yun LONG, Da-wei LIU. Sepsis Is Not Infection: Stard for Surviving Sepsis Campaign[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(5): 411-416. doi: 10.3969/j.issn.1674-9081.2018.05.007
Citation: Yun LONG, Da-wei LIU. Sepsis Is Not Infection: Stard for Surviving Sepsis Campaign[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(5): 411-416. doi: 10.3969/j.issn.1674-9081.2018.05.007

Sepsis并非感染:支持“拯救Sepsis运动”

doi: 10.3969/j.issn.1674-9081.2018.05.007
详细信息
    通讯作者:

    刘大为  电话:010-69152300, E-mail:dwliu98@163.com

  • 中图分类号: R441.9

Sepsis Is Not Infection: Stard for Surviving Sepsis Campaign

More Information
    Corresponding author: LIU Da-wei    Tel:010-69152300, E-mail:dwliu98@163.com
  • 摘要: Sepsis不同于感染,是机体对感染的反应失控而导致的危及生命的器官功能障碍。Sepsis的重点在于器官功能障碍而非感染,这可能是美国感染病学会(Infectious Disease Society of America,IDSA)与“拯救Sepsis运动(Surviving Sepsis Campaign,SSC)”在重症感染认知上的分歧。对于Sepsis而言,筛查至关重要,可更早地启动集束性治疗策略,从而改善患者预后。Sepsis的理念来源于循证医学证据及大数据研究结果,二者奠定了其坚实的理论基础。本文根据IDSA提出的争议话题,从SSC角度,阐述重症医学对Sepsis本质的认知。
    写在前面:
    2017年末,一项来自美国感染病学会(Infectious Disease Society of America,IDSA)的声明搅动了国际医学界的宁静。事情的原委还得从"拯救Sepsis运动(Surviving Sepsis Campaign,SSC) "开始。
    SSC是由美国重症医学会(Society of Critical Care Medicine,SCCM)、欧洲重症医学会和国际Sepsis论坛于2002年共同参与发起并支持的国际学术组织,旨在针对Sepsis,提高知晓率、明确诊断、改善治疗、培训专业医务人员、完善ICU之后的治疗、颁布指南性文件、实施并完成提升临床医疗水平的专项计划,其目标是Sepsis的病死率在5年内下降25%。成立之后,SSC每年组织多项、不同层次、不同类型的学术活动,一些活动或项目会邀请到十几个甚至更多的国际相关学会参与支持。这些活动中,每4年一次颁布并更新的SSC指南"Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and Septic Shock"受到国际广泛重视。重要的是,随着SSC对指南的不断完善,循证医学证据的支持力度不断增强。越来越多的报道发现,随着对SSC指南依从性的提高,Sepsis的病死率不断下降。
    2016年版的SSC指南,在对Sepsis和感染性休克重新定义、重新制定诊断标准的基础上,于2017年1月正式发布,引起了国际广泛关注。然而,就在2017年11月,IDSA在其官方期刊Clin Infect Dis发表公开立场声明,对2016年SSC指南中关于感染诊疗的推荐意见提出了质疑。声明指出,在SSC指南发表前,IDSA曾同SCCM就学术分歧点进行磋商,但最终无果,双方坚持自己的学术观点不变。由此,IDSA声明不再支持SSC指南。
    针对貌似临床常见的Sepsis和感染,为何国际医学权威学会之间会发生如此激烈的争执?我们特开辟此专栏,请专家分别从各自的角度阐述观点,同时给予综合点评。以期和大家共同发现:这个"梗"在哪里,而我自己又在哪里!
    ——北京协和医院重症医学科   刘大为
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  • 收稿日期:  2018-04-08
  • 刊出日期:  2018-09-30

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