【转载】[JAMA在线发表]：全身性感染及感染性休克最新定义（节选）

转载自CSCCM平台，很新的资料，新的脓毒症和脓毒症休克的定义，也就是诊断标准。
JAMA 2月23日才在线刊出来的。有三篇文章，有兴趣的朋友找原文来看吧。
以下转载自http://mp.weixin.qq.com/s?__biz= ... PBbkOcFwli1XKGPC#rd

Special Communication | February 23, 2016
CARING FOR THE CRITICALLY ILL PATIENT
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) FREE
Mervyn Singer, Clifford S. Deutschman, Christopher Warren Seymour, et al.JAMA. 2016; 315(8): 801-810.doi:10.1001/jama.2016.0287.


Definition of Sepsis全身性感染的定义


表1 New Terms and Definitions 新名词与定义

• Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.
  
• 全身性感染定义为针对感染的宿主反应失调引起的致命性器官功能障碍
• 
  
• Organ dysfunction can be identified as an acute change in total SOFA score ≥ 2 points consequent to the infection.
  
• 器官功能障碍指感染引起的SOFA总分急性改变≥ 2分
• 
  
• The baseline SOFA score can be assumed to be zero in patients not known to have preexisting organ dysfunction.
  
• 对于基础器官功能障碍状态未知的患者，可以假设基线SOFA评分为0
• 
  
• A SOFA score ≥ 2 reflects an overall mortality risk of approximately 10% in a general hospital population with suspected infection.
  
• Even patients presenting with modest dysfunction can deteriorate further, emphasizing the seriousness of this condition and the need for prompt and appropriate intervention, if not already being instituted.
  
• 对于可疑感染的住院患者而言，SOFA评分≥ 2分提示死亡风险约为10%。
• 即使伴有中度器官功能障碍的患者病情也可进一步恶化，这强调了全身性感染的严重性，以及及时采取适当措施的必要性
• 
  
• In lay terms, sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs.
  
• 根据通俗定义，全身性感染是感染引发的机体反应对机体组织和器官本身造成损害而导致的致命性情况
• 
  
• Patients with suspected infection who are likely to have a prolonged ICU stay or to die in the hospital can be promptly identified at the bedside with qSOFA, ie, alteration in mental status, systolic blood pressure ≤ 100 mm Hg, or respiratory rate ≥ 22/min.
  
• 在床旁通过qSOFA评分（即意识状态改变，收缩压≤ 100 mmHg，或呼吸频率≥ 22次/分）能够迅速鉴别那些需要长时间入住ICU或住院期间可能死亡的可疑感染患者
• 
  
• Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.
  
• 感染性休克是全身性感染的一种，此时出现严重的循环及细胞/代谢异常，病死率显著增加
• 
  
• Patients with septic shock can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥ 65 mm Hg and having a serum lactate level > 2 mmol/L (18 mg/dL) despite adequate volume resuscitation. With these criteria, hospital mortality is in excess of 40%.
  
• 感染性休克的诊断为确诊全身性感染并伴有持续性低血压，即使接受了充分的容量复苏治疗，仍需要升压药物维持MAP ≥ 65 mmHg且血清乳酸水平> 2 mmol/L (18 mg/dL)。根据这一标准，感染性休克的住院病死率超过40%
  

Nonspecific SIRS criteria such as pyrexia or neutrophilia will continue to aid in the general diagnosis of infection. These findings complement features of specific infections (eg, rash, lung consolidation, dysuria, peritonitis) that focus attention toward the likely anatomical source and infecting organism. However, SIRS may simply reflect an appropriate host response that is frequently adaptive. Sepsis involves organ dysfunction, indicating a pathobiology more complex than infection plus an accompanying inflammatory response alone. The task force emphasis on life-threatening organ dysfunction is consistent with the view that cellular defects underlie physiologic and biochemical abnormalities within specific organ systems. Under this terminology, “severe sepsis” becomes superfluous. Sepsis should generally warrant greater levels of monitoring and intervention, including possible admission to critical care or high-dependency facilities.

表2. qSOFA (Quick SOFA) Criteria qSOFA评分

• Respiratory rate ≥ 22/min 呼吸频率≥ 22次/分
• Altered mentation 意识状态改变
• Systolic blood pressure ≤ 100 mmHg 收缩压≤ 100 mmHg
  

Septic shock is defined as a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality (Box 3). The 2001 task force definitions described septic shock as “a state of acute circulatory failure.”10 The task force favored a broader view to differentiate septic shock from cardiovascular dysfunction alone and to recognize the importance of cellular abnormalities (Box 3). There was unanimous agreement that septic shock should reflect a more severe illness with a much higher likelihood of death than sepsis alone.

Recommendations For ICD Coding And For Lay Definitions 有关ICD编码的推荐意见

根据准确应用诊断编码的重要性的要求，表3列举了全身性感染与感染性休克新的临床标准与ICD-9-CM及ICD-10编码的相关性。
特别小组还支持近期发表的通俗定义，即“全身性感染是感染引发的机体反应对机体组织和器官本身造成损害而导致的致命性情况”，这一概念与上述定义相符。
为向普通大众宣传全身性感染的重要性，特别小组强调全身性感染可能导致死亡，尤其当未能及时发现和治疗时。
事实上，尽管在疫苗、抗生素以及急性病治疗等方面取得了长足进步，全身性感染仍然是感染导致死亡的主要原因。建议采取更加广泛的教育行动以帮助公众更好的了解这一致死性疾病。

学习。